Healthcare Provider Details

I. General information

NPI: 1811637515
Provider Name (Legal Business Name): HOLLY GENNARO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY NEALE MD

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LITTLETON RD STE 205206
WESTFORD MA
01886-3115
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3310
US

V. Phone/Fax

Practice location:
  • Phone: 978-692-9978
  • Fax: 978-589-6835
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1027267
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: