Basic Information
| Provider Information | |||||||||
| NPI: | 1003981952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLOWAY | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | RUFFIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 EAST JEFFERSON STREET | ||||||||
| Address2: | PPQA MEDICARE COMPLIANCE UNIT 6 WEST | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018166660 | ||||||||
| FaxNumber: | 3018166308 | ||||||||
| Practice Location | |||||||||
| Address1: | 6525 BELCREST RD | ||||||||
| Address2: | PRINCE GEORGE'S MEDICAL CENTER | ||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207822003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012096000 | ||||||||
| FaxNumber: | 3012096023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101052106 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD19405 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D24897 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.