Healthcare Provider Details

I. General information

NPI: 1154152288
Provider Name (Legal Business Name): JOHN HOLLOWAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHRISTIANA MEDICAL CTR
NEWARK DE
19702-1654
US

IV. Provider business mailing address

400 CHRISTIANA MEDICAL CTR
NEWARK DE
19702-1654
US

V. Phone/Fax

Practice location:
  • Phone: 302-722-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012096
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: