1558794040 NPI number — VALERIE RENEE HOLT NP

Table of content: VALERIE RENEE HOLT NP (NPI 1558794040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558794040 NPI number — VALERIE RENEE HOLT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLT
Provider First Name:
VALERIE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NYDAM
Provider Other First Name:
VALERIE
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558794040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GENERAL STREET
Provider Second Line Business Mailing Address:
HOSPITAL MEDICINE
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-744-3839
Provider Business Mailing Address Fax Number:
781-744-1597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GENERAL STREET
Provider Second Line Business Practice Location Address:
HOSPITAL MEDICINE
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-744-3839
Provider Business Practice Location Address Fax Number:
781-744-1597
Provider Enumeration Date:
08/20/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN2261962 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN2261962 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)