Provider Demographics
NPI:1578603189
Name:HOLT, PETER ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2618
Mailing Address - Country:US
Mailing Address - Phone:410-877-8199
Mailing Address - Fax:
Practice Address - Street 1:4014 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1104
Practice Address - Country:US
Practice Address - Phone:410-734-4290
Practice Address - Fax:410-734-4273
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022472207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD74633Medicare UPIN
MD832RMedicare PIN