1235109844 NPI number — DR. DENISE EDGECOMBE HOLLAND M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235109844 NPI number — DR. DENISE EDGECOMBE HOLLAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
DENISE
Provider Middle Name:
EDGECOMBE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDGECOMBE
Provider Other First Name:
ROSALYN
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235109844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 CHAPEL RIDGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21076-1763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-237-5425
Provider Business Mailing Address Fax Number:
443-517-6864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 CHAPEL RIDGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21076-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-237-5425
Provider Business Practice Location Address Fax Number:
443-517-6864
Provider Enumeration Date:
01/25/2006

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: 2084P0800X , with the licence number:  10825 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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