=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164402970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY A HOLMES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2006
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 RAILROAD AVE
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21636-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-634-2380
-----------------------------------------------------
Fax | 833-908-2287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 RAILROAD AVE
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21636-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-634-2380
-----------------------------------------------------
Fax | 833-908-2287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 19741
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C10011788
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | D0096355
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------