Healthcare Provider Details

I. General information

NPI: 1982993234
Provider Name (Legal Business Name): ROBERT FRANKLIN HOLUB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 QUARRY HILL ROAD CHP - LEE FAMILY PRACTICE
LEE MA
01238
US

IV. Provider business mailing address

P.O. BOX 30
GREAT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-243-0536
  • Fax: 413-243-8040
Mailing address:
  • Phone: 413-528-9311
  • Fax: 413-644-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101253834
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number274261
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number258268
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: