Healthcare Provider Details

I. General information

NPI: 1083143770
Provider Name (Legal Business Name): CHRISTINE ANNE HOLLOWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE STE 104
SCRANTON PA
18510-1636
US

IV. Provider business mailing address

743 JEFFERSON AVE STE 104
SCRANTON PA
18510-1636
US

V. Phone/Fax

Practice location:
  • Phone: 570-207-0433
  • Fax:
Mailing address:
  • Phone: 570-207-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT213666
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN35597
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD481784
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: