Provider Demographics
NPI:1770580458
Name:HOLZER, CYNTHIA L (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:HOLZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PILGRIM PKWY
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-4120
Mailing Address - Country:US
Mailing Address - Phone:401-463-3771
Mailing Address - Fax:401-463-9072
Practice Address - Street 1:27 PILGRIM PKWY
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-4120
Practice Address - Country:US
Practice Address - Phone:401-463-3771
Practice Address - Fax:401-463-9072
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10652207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7009040Medicaid
RIH20083Medicare UPIN