Healthcare Provider Details

I. General information

NPI: 1164817581
Provider Name (Legal Business Name): MEREDITH SULLIVAN HOLUB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH SULLIVAN LOH D.O.

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 923
HARTFORD CT
06106-5529
US

IV. Provider business mailing address

85 SEYMOUR ST STE 923
HARTFORD CT
06106-5529
US

V. Phone/Fax

Practice location:
  • Phone: 860-524-4550
  • Fax: 860-524-4465
Mailing address:
  • Phone: 860-524-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number67818
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number67818
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: