Healthcare Provider Details

I. General information

NPI: 1275596629
Provider Name (Legal Business Name): MICHAEL J HOLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 RANDALL RD
PRINCETON NJ
08540-3611
US

IV. Provider business mailing address

139 RANDALL RD
PRINCETON NJ
08540-3611
US

V. Phone/Fax

Practice location:
  • Phone: 732-672-0701
  • Fax:
Mailing address:
  • Phone: 732-672-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number25MA06000800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD056219L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA06000800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: