MEDICARE: DR. NATHAN THOMAS HOLMES MD

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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	25MA09150600	NJ

General Provider Information

NPI Number	:	1134370166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN THOMAS HOLMES MD

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	609-267-9400
Fax Number	:	856-270-2786

Provider Business Practice Location Address
First Line	:	570 EGG HARBOR RD STE C4
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-2359
Country	:	US
Telephone Number	:	609-267-9400
Fax Number	:	856-270-2786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	05/20/2026

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