Provider Demographics
NPI:1861452260
Name:HOLDER, MARK BRITT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRITT
Last Name:HOLDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-3880
Mailing Address - Fax:256-265-3886
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-3880
Practice Address - Fax:256-265-3886
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26900207R00000X, 208M00000X
LA025555208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL194891Medicaid
LA1045314Medicaid
P00440624Medicare PIN
ALH61482Medicare UPIN
AL009911827Medicaid
0656550001Medicare NSC
LA313721YH97Medicare PIN