Individual
MS. MARYBETH HOLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
428 COLUMBUS AVENUE, DERMATOLOGY, NEW HAVEN, CT 06519-1233
(203) 503-3000
(203) 503-3224
Mailing address
400 COLUMBUS AVENUE, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-1233
(203) 503-3000
(203) 503-6515
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
6944
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008075168
—
CT
01
—
P00067536
RAILROAD MEDICARE
NH
01
—
P61979
ANTHEM BCBS
NH
Enumeration date
09/23/2006
Last updated
10/30/2020
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