Provider Demographics
NPI:1871587634
Name:HOLT, LAWRENCE B JR (MD FACP)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:B
Last Name:HOLT
Suffix:JR
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 ROURK ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4128
Mailing Address - Country:US
Mailing Address - Phone:843-692-5000
Mailing Address - Fax:843-692-5015
Practice Address - Street 1:8121 ROURK ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4128
Practice Address - Country:US
Practice Address - Phone:843-692-5000
Practice Address - Fax:843-692-5015
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11181207RH0003X
NC200100151207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC111818Medicaid
NC7905862Medicaid
D17687Medicare UPIN
SC111818Medicaid
NC7905862Medicaid
SCD176876528Medicare PIN
SCD176876527Medicare PIN
NC2021709Medicare PIN