Provider Demographics
NPI:1679646814
Name:HOLSTEIN, EDWIN C (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:C
Last Name:HOLSTEIN
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 1:20 PARK PLZ
Mailing Address - Street 2:SUITE 628
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4303
Mailing Address - Country:US
Mailing Address - Phone:617-357-4901
Mailing Address - Fax:
Practice Address - Street 1:20 PARK PLZ
Practice Address - Street 2:SUITE 628
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4303
Practice Address - Country:US
Practice Address - Phone:617-357-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA344462083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine