Provider Demographics
NPI:1821082264
Name:HOLT, WILLIAM R JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:HOLT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1515 DOCTORS CIR
Mailing Address - Street 2:HANOVER MEDICAL SPECIALISTS, P.A.
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7403
Mailing Address - Country:US
Mailing Address - Phone:910-763-5182
Mailing Address - Fax:910-763-0291
Practice Address - Street 1:1515 DOCTORS CIR
Practice Address - Street 2:HANOVER MEDICAL SPECIALISTS, P.A.
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-763-5182
Practice Address - Fax:910-763-0291
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC24256207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943453Medicaid
NC8943453Medicaid
NCC81384Medicare UPIN