1790720407 NPI number — MR. RICHARD JAMES HOLLEY

Table of content: MR. RICHARD JAMES HOLLEY (NPI 1790720407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790720407 NPI number — MR. RICHARD JAMES HOLLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLEY
Provider First Name:
RICHARD
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLEY
Provider Other First Name:
RICHARD
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790720407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4104 LOMAR TER
Provider Second Line Business Mailing Address:
GREENS AT MANORWOOD
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21771-3909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-829-6779
Provider Business Mailing Address Fax Number:
301-754-7342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 FOREST GLEN RD
Provider Second Line Business Practice Location Address:
PHYSICAL MEDICINE AND REHAB DPT
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-1483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-754-7340
Provider Business Practice Location Address Fax Number:
301-754-7342
Provider Enumeration Date:
06/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X , with the licence number:  03635 , 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)