Healthcare Provider Details

I. General information

NPI: 1376513143
Provider Name (Legal Business Name): MICHAEL GERALD HOLLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST THE WOUND HEALING CENTER
GLENS FALLS NY
12801-4403
US

IV. Provider business mailing address

PO BOX 304
GLENS FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1500
  • Fax: 518-926-1505
Mailing address:
  • Phone: 518-926-1500
  • Fax: 518-926-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number176961
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number176961
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number176961
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number176961
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: