Provider Demographics
NPI:1285956979
Name:DR. BARON HOLT
Entity type:Organization
Organization Name:DR. BARON HOLT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARON
Authorized Official - Middle Name:GABLE
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:423-748-5095
Mailing Address - Street 1:2315 LYNN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6743
Mailing Address - Country:US
Mailing Address - Phone:423-748-5095
Mailing Address - Fax:
Practice Address - Street 1:2315 LYNN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6743
Practice Address - Country:US
Practice Address - Phone:423-748-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4061261QC1500X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service