Healthcare Provider Details

I. General information

NPI: 1649513128
Provider Name (Legal Business Name): MICHOL D HOLLOWAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 EASTERN PKWY
BROOKLYN NY
11225-1604
US

IV. Provider business mailing address

55 WATER ST 12TH FLOOR, CREDENTIALING
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-4800
  • Fax:
Mailing address:
  • Phone: 646-680-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number284062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: