Provider Demographics
NPI:1003981952
Name:HOLLOWAY, JOSHUA RUFFIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RUFFIN
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:6525 BELCREST RD
Practice Address - Street 2:PRINCE GEORGE'S MEDICAL CENTER
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:301-209-6000
Practice Address - Fax:301-209-6023
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101052106207Q00000X
DCMD19405207Q00000X
MDD24897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29475Medicare UPIN
018992K92Medicare ID - Type Unspecified