| Doctor Name: | DR. BENNETT ROY HOLLENBERG |
| NPI Number: | 1164496402 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 29595 |
| Business Practice Address: | 3623 Latrobe Dr Suite 216 Charlotte, NC - 282111187 |
| Business Phone Number: | 7043321291 |
| Business Fax Number: | 7043325206 |
| Mailing Address: | Po Box 221249, CHARLOTTE |
| State: | NC |
| Postal Code: | 282221249 |
| Phone Number: | 7043321291 |
| Fax Number: | 7043325206 |
| NPI Enumeration Date: | 02/14/2006 |
| NPI Last Update Date: | 01/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 29595 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |