Provider Demographics
NPI:1174599450
Name:HOLM, KRISTIN A (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:HOLM
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 1:149 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4974
Mailing Address - Country:US
Mailing Address - Phone:207-872-1715
Mailing Address - Fax:207-872-1725
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-872-1715
Practice Address - Fax:207-872-1725
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014498207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME268730099Medicaid
MEMM7181Medicare PIN
MEG65853Medicare UPIN
MEMM718101Medicare PIN
ME290010679Medicare PIN
MEEX8482Medicare PIN
ME268730099Medicaid