Healthcare Provider Details

I. General information

NPI: 1871586263
Provider Name (Legal Business Name): DOUGLAS S. HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 04/16/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 34TH ST FL 4
NEW YORK NY
10016-4972
US

IV. Provider business mailing address

550 1ST AVE TH576
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7149
  • Fax:
Mailing address:
  • Phone: 212-263-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number200262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: