Healthcare Provider Details

I. General information

NPI: 1063497311
Provider Name (Legal Business Name): HOLLY J OH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17840 CUMBERLAND RD
NOBLESVILLE IN
46060-5409
US

IV. Provider business mailing address

9615 E 148TH ST STE 1
NOBLESVILLE IN
46060-4371
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax: 317-674-0060
Mailing address:
  • Phone: 317-574-1254
  • Fax: 317-674-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01087411A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204101
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: