Provider Demographics
NPI:1922098474
Name:HOLMVANG, GODTFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:GODTFRED
Middle Name:
Last Name:HOLMVANG
Suffix:
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 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-6824
Mailing Address - Fax:617-726-3852
Practice Address - Street 1:139 MAIN ST
Practice Address - Street 2:BOSTON HEART FOUNDATION
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1530
Practice Address - Country:US
Practice Address - Phone:617-726-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ09026OtherBCBS MA
MA060102OtherTUFTS HEALTH PLAN
MA3060900Medicaid
MA3060900Medicaid
E31314Medicare UPIN