Basic Information
Provider Information
NPI: 1154520948
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLMES
FirstName: DANIELLE
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8110 MAPLE LAWN BLVD STE 235
Address2:  
City: FULTON
State: MD
PostalCode: 207592694
CountryCode: US
TelephoneNumber: 3013408339
FaxNumber: 3013409027
Practice Location
Address1: 1715 N GEORGE MASON DR
Address2: SUITE 302
City: ARLINGTON
State: VA
PostalCode: 222053609
CountryCode: US
TelephoneNumber: 7038164152
FaxNumber: 7035271169
Other Information
ProviderEnumerationDate: 07/12/2007
LastUpdateDate: 10/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X0101243294VAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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