Provider Demographics
NPI:1669475216
Name:HOLT, EDWARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8902
Mailing Address - Country:US
Mailing Address - Phone:667-204-7000
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-268-8862
Practice Address - Fax:410-280-4701
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD30372207XX0004X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152904ZDR9Medicare PIN
DC153127ZDTRMedicare PIN