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NPI Code Detail

MEDICARE: MR. CHARLES ALLEN HOLT D.O.

MEDICARE: MR. CHARLES ALLEN HOLT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician02000982IN

General Provider Information

NPI Number : 1083680284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES ALLEN HOLT D.O.
Provider Business Mailing Address
First Line : 845 WILLIAMS COVE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-5343
Country : US
Telephone Number : 317-255-7446
Fax Number : 317-554-0193
Provider Business Practice Location Address
First Line : VA MEDICAL CENTER
Second Line : 1481 WEST 10TH STREET
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-554-0000
Fax Number : 317-988-5359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 07/21/2022

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