1457496614 NPI number — ELWOOD S. HOLLAND, M.D., P.A.

Table of content: (NPI 1457496614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457496614 NPI number — ELWOOD S. HOLLAND, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELWOOD S. HOLLAND, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457496614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/24/2009
NPI Reactivation Date:
09/04/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6005 LANDOVER RD
Provider Second Line Business Mailing Address:
STE. 3
Provider Business Mailing Address City Name:
CHEVERLY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20785-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-341-1177
Provider Business Mailing Address Fax Number:
301-341-5659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6005 LANDOVER RD
Provider Second Line Business Practice Location Address:
STE. 3
Provider Business Practice Location Address City Name:
CHEVERLY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-341-1177
Provider Business Practice Location Address Fax Number:
301-341-5659
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
ELWOOD
Authorized Official Middle Name:
SAMUEL
Authorized Official Title or Position:
PRESIDENT-PHYSICIAN
Authorized Official Telephone Number:
301-341-1177

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D20989 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0795 . This is a "BCBSNCA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 188621500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080187474 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 2107922 . This is a "AETNA,INS." identifier . This identifiers is of the category "OTHER".
  • Identifier: 4296 . This is a "BCBS(CAREFIRST)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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