Healthcare Provider Details

I. General information

NPI: 1912387143
Provider Name (Legal Business Name): HEATHER MARY HOLAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 PENNY LN
CONCORD NC
28025-1221
US

IV. Provider business mailing address

335 PENNY LN
CONCORD NC
28025-1221
US

V. Phone/Fax

Practice location:
  • Phone: 704-784-5901
  • Fax: 704-784-5903
Mailing address:
  • Phone: 704-784-5901
  • Fax: 704-784-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2019-01954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: