Provider Demographics
NPI:1912188483
Name:DESENA, HOLLY CAPITANO (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CAPITANO
Last Name:DESENA
Suffix:
Gender:F
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:STE 203
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4251
Practice Address - Country:US
Practice Address - Phone:704-381-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02555208000000X, 2080P0202X, 2080P0202X
OH35.1230282080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1003034Medicaid