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NPI Code Detail

MEDICARE: REBECCA ELAYNE HOLDREN M.D.

MEDICARE: REBECCA ELAYNE HOLDREN M.D.
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
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician20936SC
2208100000XPhysical Medicine & Rehabilitation Physician20936SC

General Provider Information

NPI Number : 1245217322
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ELAYNE HOLDREN M.D.
Provider Business Mailing Address
First Line : 1 INDEPENDENCE PT STE 212
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-4536
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 DOCTORS DR
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-5622
Country : US
Telephone Number : 864-797-7100
Fax Number : 864-797-7105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 10/18/2019

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