Healthcare Provider Details

I. General information

NPI: 1740920131
Provider Name (Legal Business Name): BRYAN STEWART HOLTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

115 POWERS RD
SUDBURY MA
01776-1029
US

V. Phone/Fax

Practice location:
  • Phone: 978-807-2043
  • Fax:
Mailing address:
  • Phone: 978-807-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number14279445-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: