Provider Demographics
NPI:1780640839
Name:HOLDEN, KENTON R (MD)
Entity Type:Individual
Prefix:DR
First Name:KENTON
Middle Name:R
Last Name:HOLDEN
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:PO BOX 1047
Mailing Address - Street 2:GREENWOOD GENETIC CENTER-MT. PLEASANT OFFICE
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-1047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 GREGOR MENDEL CIR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2316
Practice Address - Country:US
Practice Address - Phone:864-941-8100
Practice Address - Fax:864-941-8114
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCC477432080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC148165Medicaid
SC148165Medicaid