Provider Demographics
NPI:1619083565
Name:HOLMGREN, ERIC P (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:HOLMGREN
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 1:77 HOSPITAL AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2538
Mailing Address - Country:US
Mailing Address - Phone:413-664-4100
Mailing Address - Fax:
Practice Address - Street 1:ORAL AND FACIAL SURGERY ASSOCIATES
Practice Address - Street 2:77 HOSPITAL DRIVE
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-664-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04324122300000X
VT016.0002228122300000X
NH18361204E00000X
MA227532204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0215929Medicaid
VT1012894Medicaid
I70198Medicare UPIN
MAX20164Medicare PIN
VTVN4180Medicare PIN