Provider Demographics
NPI:1801856455
Name:COBLENTZ, HOLLIS S (DO)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:S
Last Name:COBLENTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ELBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2711
Mailing Address - Country:US
Mailing Address - Phone:508-831-3002
Mailing Address - Fax:
Practice Address - Street 1:10 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2898
Practice Address - Country:US
Practice Address - Phone:508-368-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine