Provider Demographics
NPI:1003908898
Name:HOLMES, EDNA C (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:C
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ROSEDALE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 ROSEDALE CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3016
Practice Address - Country:US
Practice Address - Phone:703-494-3070
Practice Address - Fax:703-491-9501
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000695213ES0000X, 213ES0131X, 213E00000X, 213EP0504X, 213EP1101X, 213ER0200X
DCP0474213ES0000X, 213ES0131X, 213E00000X, 213EP0504X, 213EP1101X, 213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9302409Medicaid
DC5407OtherPODIATRY
VA026083OtherPODIATRY
VA00Y336HO1OtherINDIVIUAL PTAN
DC5407OtherPODIATRY
VA480000105Medicare ID - Type UnspecifiedPODIATRY