Basic Information
| Provider Information | |||||||||
| NPI: | 1134135338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLOWELL | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182130478 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 HACKETT BLVD | ||||||||
| Address2: | MC 208 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122083436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182623341 | ||||||||
| FaxNumber: | 5182626660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2088P0231X | 175342-1 | NY | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | 2125582 | 01 | VA | ALLIANCE/MDIPA | OTHER | 010066379 | 05 | VA | MEDICAID | 2125582 | 01 | VA | MAMSI/OPTIMUM CHOICE | OTHER | 4239662 | 01 | VA | AETNA | OTHER | 138022 | 01 | VA | ANTHEM BCBS | OTHER | 3116108340006E | 01 | VA | CIGNA | OTHER | 76601 | 01 | VA | OPTIMA/SENTARA HEALTH | OTHER | 01095692 | 05 | NY | MEDICAID | 311610834 | 01 | VA | NC HEALTH CHOICE | OTHER | 790668J | 01 | VA | NORTH CAROLINA MEDICAID | OTHER |