Provider Demographics
NPI:1891707675
Name:HOLLEMAN, JEREMIAH HENRY JR (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:HENRY
Last Name:HOLLEMAN
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:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-355-8188
Mailing Address - Fax:704-355-8192
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-8188
Practice Address - Fax:704-355-8192
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28044208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC43110OtherBCBS
NC7943110Medicaid
NC1891707675Medicaid
P00245246OtherRAILROAD MEDICARE
SCN28044Medicaid
NC207331BMedicare PIN
P00245246OtherRAILROAD MEDICARE
NC7943110Medicaid