Provider Demographics
NPI:1548386329
Name:HOLTEN, TERRY K (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:K
Last Name:HOLTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S NELSON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2067
Mailing Address - Country:US
Mailing Address - Phone:937-382-7221
Mailing Address - Fax:937-382-7027
Practice Address - Street 1:111 S NELSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2067
Practice Address - Country:US
Practice Address - Phone:937-382-7221
Practice Address - Fax:937-382-7027
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-048984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0566696Medicaid