Healthcare Provider Details

I. General information

NPI: 1679687289
Provider Name (Legal Business Name): PETER AMBERG HOLLMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL SUITE 102
RIVERSIDE RI
02915-2212
US

IV. Provider business mailing address

110 ELM ST
PROVIDENCE RI
02903-4626
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4010
  • Fax: 401-649-4011
Mailing address:
  • Phone: 401-443-4992
  • Fax: 401-537-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD05708
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD05708
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: