1114595196 NPI number — DR. LAUREN DANIELLE HOLDER

Table of content: DR. LAUREN DANIELLE HOLDER (NPI 1114595196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114595196 NPI number — DR. LAUREN DANIELLE HOLDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDER
Provider First Name:
LAUREN
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1114595196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1032 MILLER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWNSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21032-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-370-8601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1132 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODENTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21113-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-370-8601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2021

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: 103TB0200X , with the licence number:  06983 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 06983 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 06983 , 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)