1093979130 NPI number — MARIA HOLMES, MD, PLLC

Table of content: (NPI 1093979130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093979130 NPI number — MARIA HOLMES, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA HOLMES, MD, PLLC
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:
6
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:
1093979130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4517 SW COLLEGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98116-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-651-4338
Provider Business Mailing Address Fax Number:
425-651-4388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22500 SE 64TH PL
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-8111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-651-4338
Provider Business Practice Location Address Fax Number:
425-651-4388
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
CHERNYKH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
425-651-4338

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD00037841 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8245193 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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