Provider Demographics
NPI:1851452395
Name:HOLL, WALDEN MARTIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALDEN
Middle Name:MARTIN
Last Name:HOLL
Suffix:JR
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 1:256 KINGS HWY E
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1907
Mailing Address - Country:US
Mailing Address - Phone:856-428-4912
Mailing Address - Fax:856-428-2132
Practice Address - Street 1:256 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1907
Practice Address - Country:US
Practice Address - Phone:856-428-4912
Practice Address - Fax:856-428-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA025016002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H0018956Medicare ID - Type Unspecified