Basic Information
| Provider Information | |||||||||
| NPI: | 1356565915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLIAN | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 WATERSIDE CT | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210372708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102919787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 SHERRY LN | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206783275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104149229 | ||||||||
| FaxNumber: | 4104149339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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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 | 363A00000X | MA-002998-L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.