Healthcare Provider Details

I. General information

NPI: 1225347990
Provider Name (Legal Business Name): ASHLEY M. HOLMES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY M. SNYDER PA-C

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S. HANOVER STREET
BALTIMORE MD
21222-1233
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-3509
  • Fax:
Mailing address:
  • Phone: 856-686-4316
  • Fax: 856-848-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC004290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: