MEDICARE: MICHAEL D HOLLAND 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	207RN0300X	Nephrology Physician	23848	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	110095566	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	43091	OTHER	NC	BCBSNC
3	25489	OTHER	NC	MEDCOST
4	5885355	OTHER	NC	CIGNA HEALTHCARE

General Provider Information

NPI Number	:	1942294681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D HOLLAND MD

Provider Business Mailing Address
First Line	:	EASTERN NEPHROLOGY ASSOCIATES PLLC
Second Line	:	1302 MEDICAL CENTER DRIVE
City	:	WILMINGTON
State	:	NC
Zip	:	28401-0200
Country	:	US
Telephone Number	:	910-343-9800
Fax Number	:	910-343-8650

Provider Business Practice Location Address
First Line	:	EASTERN NEPHROLOGY ASSOCIATES PLLC
Second Line	:	2021 NORTH POINT BLVD SUITE 106
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2224
Country	:	US
Telephone Number	:	843-663-1401
Fax Number	:	910-778-1433

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	03/07/2022

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