Healthcare Provider Details

I. General information

NPI: 1205832284
Provider Name (Legal Business Name): RICHARD T HOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WIMBLEDON SQ
CHESAPEAKE VA
23320-4931
US

IV. Provider business mailing address

100 WIMBLEDON SQ
CHESAPEAKE VA
23320-4931
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-5145
  • Fax: 757-436-2480
Mailing address:
  • Phone: 757-547-5145
  • Fax: 757-436-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101034150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: