Healthcare Provider Details

I. General information

NPI: 1144052903
Provider Name (Legal Business Name): HOLOMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 HUBBARD DR
ROCKVILLE MD
20852-4823
US

IV. Provider business mailing address

5920 HUBBARD DR
ROCKVILLE MD
20852-4823
US

V. Phone/Fax

Practice location:
  • Phone: 301-984-9791
  • Fax: 301-816-0907
Mailing address:
  • Phone: 301-984-9791
  • Fax: 301-816-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY DEAN VINSTON JR.
Title or Position: VP OF OPERATIONS
Credential:
Phone: 240-401-3585