Healthcare Provider Details

I. General information

NPI: 1407148828
Provider Name (Legal Business Name): HOLLY DENISE BRINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY DENISE LANG

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 07/21/2022
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TOLEDO CHILDREN'S HOSPITAL 2142 NORTH COVE BLVD, 3RD FLOOR
TOLEDO OH
43606
US

IV. Provider business mailing address

NORTHWEST OHIO NEONATAL ASSOC., INC. 2142 NORTH COVE BLVD, 3RD FLOOR
TOLEDO OH
43606
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4225
  • Fax: 419-479-6193
Mailing address:
  • Phone: 419-291-4225
  • Fax: 419-479-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number131043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: