Provider Demographics
NPI:1023125994
Name:HAHN, HOLLY B (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:B
Last Name:HAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 BRAINARD WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2907
Mailing Address - Country:US
Mailing Address - Phone:585-734-9118
Mailing Address - Fax:
Practice Address - Street 1:999 BRUBAKER DR STE 3
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3505
Practice Address - Country:US
Practice Address - Phone:937-668-9850
Practice Address - Fax:937-668-8668
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230724-1174400000X
OH35.094838207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH408710Medicare PIN
NYF72919Medicare UPIN
F72919Medicare UPIN
NY16828AMedicare ID - Type Unspecified