Provider Demographics
NPI:1073593208
Name:HOLMES, ANDREW S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR STE 180
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3633
Mailing Address - Country:US
Mailing Address - Phone:301-530-1010
Mailing Address - Fax:301-897-8597
Practice Address - Street 1:1635 N GEORGE MASON DR STE 180
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3633
Practice Address - Country:US
Practice Address - Phone:301-530-1010
Practice Address - Fax:301-897-8597
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232842207XS0114X
DCMD034415207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC403399000Medicaid
DC035367300Medicaid
DC010025125Medicaid
DC010025125Medicaid
DC0128482O59Medicare ID - Type UnspecifiedTRAILBLAZER
DC035367300Medicaid