Provider Demographics
NPI:1316991268
Name:HOLLAND, GREG C (MD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:C
Last Name:HOLLAND
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 1:6075 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5131
Mailing Address - Country:US
Mailing Address - Phone:614-864-6363
Mailing Address - Fax:614-864-2248
Practice Address - Street 1:85 MCNAUGHTEN RD STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5111
Practice Address - Country:US
Practice Address - Phone:614-863-2745
Practice Address - Fax:614-863-2759
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057302208200000X, 208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000120306OtherATHEM
OH240003964OtherMEDICARE RAILROAD
OH4412279OtherAETNA
OH0728734Medicaid
OH4412279OtherAETNA
OH0728734Medicaid
OK0756931Medicare PIN