=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235670662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLAND PLASTIC SURGERY & AESTHETICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2017
-----------------------------------------------------
Last Update Date | 08/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74 GRAY RD STE 1B
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-835-4777
-----------------------------------------------------
Fax | 207-835-4779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 GRAY RD SUITE 1B
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-835-4777
-----------------------------------------------------
Fax | 207-835-4779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | DR. SARAH WEILAND HOLLAND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 207-835-4777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------