=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578603189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER ANTHONY HOLT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 09/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4014 PHILADELPHIA RD
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21009-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-734-4290
-----------------------------------------------------
Fax | 410-734-4273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 SUMMIT DR
-----------------------------------------------------
City | FALLSTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21047-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-877-8199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | D0022472
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------