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NPI Code Detail

MEDICARE: DR. HOLLY J OH MD

MEDICARE: DR. HOLLY J OH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician01087411AIN
2208000000XPediatrics Physician204101MA

General Provider Information

NPI Number : 1063497311
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOLLY J OH MD
Provider Business Mailing Address
First Line : 9615 E 148TH ST STE 1
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-4371
Country : US
Telephone Number : 317-574-1254
Fax Number : 317-674-0060
Provider Business Practice Location Address
First Line : 17840 CUMBERLAND RD
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-5409
Country : US
Telephone Number : 317-574-1254
Fax Number : 317-674-0060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 11/25/2025

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