MEDICARE: DR. LAUREN C. HOLDERITH M.D.

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	207R00000X	Internal Medicine Physician	ME101206	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00829069	OTHER	FL	RAILROAD MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477745289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN C. HOLDERITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10744
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-8744
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3890 TAMPA RD
Second Line	:	SUITE 305
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3677
Country	:	US
Telephone Number	:	727-781-3160
Fax Number	:	727-533-5900

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

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	09/06/2013

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Directions to “ DR. LAUREN C. HOLDERITH M.D.” Practice Location

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