Basic Information
| Provider Information | |||||||||
| NPI: | 1912032103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLROYD | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 20TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257032071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911500 | ||||||||
| FaxNumber: | 3046911510 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 20TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257032071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911500 | ||||||||
| FaxNumber: | 3046911510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101048094 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X | 25322 | WV | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 2084P0800X | 25322 | WV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 7135742 | 05 | VA | MEDICAID |