Provider Demographics
NPI:1285605642
Name:HOLM, RICHARD PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PHILLIP
Last Name:HOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:171 NC HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6460
Mailing Address - Country:US
Mailing Address - Phone:252-537-5631
Mailing Address - Fax:252-537-7198
Practice Address - Street 1:171 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-5639
Practice Address - Fax:252-537-7198
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401073207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139AMOtherBLUE CROSS/ BLUE SHIELD
NCP00670232OtherRR MEDICARE
NC139AMOtherBLUE CROSS/ BLUE SHIELD
NC139AMOtherBLUE CROSS/ BLUE SHIELD
NCE58733Medicare UPIN
NC2037989BMedicare PIN