MEDICARE: DR. PETER AMBERG HOLLMANN 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD05708	RI
2	207R00000X	Internal Medicine Physician	MD05708	RI

General Provider Information

NPI Number	:	1679687289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER AMBERG HOLLMANN MD

Provider Business Mailing Address
First Line	:	110 ELM ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-4626
Country	:	US
Telephone Number	:	401-443-4992
Fax Number	:	401-537-7241

Provider Business Practice Location Address
First Line	:	375 WAMPANOAG TRL
Second Line	:	SUITE 102
City	:	RIVERSIDE
State	:	RI
Zip	:	02915-2212
Country	:	US
Telephone Number	:	401-649-4010
Fax Number	:	401-649-4011

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	10/17/2022

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