Healthcare Provider Details

I. General information

NPI: 1962496455
Provider Name (Legal Business Name): TRUDI KAY HOLT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SHENANDOAH AVE
FRONT ROYAL VA
22630-3547
US

IV. Provider business mailing address

2418 JONES RD
WINCHESTER VA
22602-6603
US

V. Phone/Fax

Practice location:
  • Phone: 540-636-0300
  • Fax:
Mailing address:
  • Phone: 214-912-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036308
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: