Healthcare Provider Details

I. General information

NPI: 1659931129
Provider Name (Legal Business Name): AATIRAH HOLMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 KING ST STE 100
ALEXANDRIA VA
22302-4420
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4110
  • Fax:
Mailing address:
  • Phone: 571-423-5741
  • Fax: 703-289-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.074991
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101275665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: