Provider Demographics
NPI:1871551424
Name:HOLT, DAPHNE J (MD)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:J
Last Name:HOLT
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 1:41 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4145
Mailing Address - Country:US
Mailing Address - Phone:617-726-7618
Mailing Address - Fax:
Practice Address - Street 1:149 13TH ST
Practice Address - Street 2:MGH EAST
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2020
Practice Address - Country:US
Practice Address - Phone:617-726-7618
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2098692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry