Provider Demographics
NPI:1336195676
Name:HOLLER, MARIANNE (DO)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HOLLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:STE D1
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2136
Mailing Address - Country:US
Mailing Address - Phone:732-571-1000
Mailing Address - Fax:732-784-9704
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:STE D1
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2136
Practice Address - Country:US
Practice Address - Phone:732-571-1000
Practice Address - Fax:732-784-9704
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB007885200207QH0002X, 208M00000X
NJ25MB07885200208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0109428Medicaid
NJI54623Medicare UPIN
NJ101627AEDMedicare PIN