Provider Demographics
NPI:1336158286
Name:HOLLER, EDWIN HOBBS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:HOBBS
Last Name:HOLLER
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 1:500 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5113
Mailing Address - Country:US
Mailing Address - Phone:828-430-9566
Mailing Address - Fax:828-430-9935
Practice Address - Street 1:500 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5113
Practice Address - Country:US
Practice Address - Phone:828-430-9566
Practice Address - Fax:828-430-9935
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300154208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943121Medicaid
43121OtherBCBS
E50766Medicare UPIN
NC2186159Medicare ID - Type Unspecified