Provider Demographics
NPI:1649449364
Name:HOLDER, MARITZA DEBY (MD)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:DEBY
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1025 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4229
Mailing Address - Country:US
Mailing Address - Phone:860-696-2400
Mailing Address - Fax:860-696-2410
Practice Address - Street 1:1260 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4362
Practice Address - Country:US
Practice Address - Phone:860-571-7253
Practice Address - Fax:860-258-3600
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2010-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0383692083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNPIOther1649449364