Provider Demographics
NPI:1124092846
Name:HOLLON, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:HOLLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2241
Mailing Address - Country:US
Mailing Address - Phone:937-382-0918
Mailing Address - Fax:937-383-1123
Practice Address - Street 1:222 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2241
Practice Address - Country:US
Practice Address - Phone:937-382-0918
Practice Address - Fax:937-383-1123
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-038494H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0437601Medicaid
OH110094519Medicare PIN
OHA77485Medicare UPIN
OH010033217Medicare PIN
OH0437601Medicaid
OH7373091Medicare PIN