Provider Demographics
NPI:1356393136
Name:HOLEVAS, JOHN G (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:HOLEVAS
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2127
Mailing Address - Fax:704-316-2136
Practice Address - Street 1:1918 RANDOLPH RD STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1111
Practice Address - Country:US
Practice Address - Phone:704-384-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943099Medicaid
SCN31530Medicaid
NC207323A, BMedicare ID - Type Unspecified
NCC84534Medicare UPIN
SCN31530Medicaid