MEDICARE: DR. EDWARD S HOLT 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
1	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	D30372	MD
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	D30372	MD

General Provider Information

NPI Number	:	1669475216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD S HOLT MD

Provider Business Mailing Address
First Line	:	201 DEFENSE HWY
Second Line	:	STE 100
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-8902
Country	:	US
Telephone Number	:	667-204-7000
Fax Number	:	443-481-6515

Provider Business Practice Location Address
First Line	:	2000 MEDICAL PKWY
Second Line	:	SUITE 101
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3742
Country	:	US
Telephone Number	:	410-268-8862
Fax Number	:	410-280-4701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/25/2018

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