Healthcare Provider Details

I. General information

NPI: 1003908898
Provider Name (Legal Business Name): EDNA C HOLMES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ROSEDALE CT
WOODBRIDGE VA
22191-3016
US

IV. Provider business mailing address

1700 ROSEDALE CT
WOODBRIDGE VA
22191-3016
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-3070
  • Fax: 703-491-9501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000695
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP0474
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number0103000695
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberP0474
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0103000695
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberP0474
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number0103000695
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberP0474
License Number StateDC
# 9
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0103000695
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberP0474
License Number StateDC
# 11
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000695
License Number StateVA
# 12
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberP0474
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: