Basic Information
| Provider Information | |||||||||
| NPI: | 1467578005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | EDGAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 SPEAR ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054459132 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | DIVISION OF DERMATOLOGY, WP-5 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028474570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 03/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 042-0011372 | VT | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | 042-0011372 | VT | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207NS0135X | 042-0011372 | VT | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.