Healthcare Provider Details

I. General information

NPI: 1316681612
Provider Name (Legal Business Name): HOLLY ALLISON FARKOSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

8260 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-6300
  • Fax:
Mailing address:
  • Phone: 804-764-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1316681612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: