Healthcare Provider Details

I. General information

NPI: 1528595618
Provider Name (Legal Business Name): HOLLY MICHELLE COFFMAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY MICHELLE JONES AU.D.

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-2983
US

IV. Provider business mailing address

18217 PALADIN DR
OLNEY MD
20832
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 240-620-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01391
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001653
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: