Provider Demographics
NPI:1083759708
Name:HOLMES, FREDERICK C (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
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 1:11 CREST RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9701
Mailing Address - Country:US
Mailing Address - Phone:802-527-8189
Mailing Address - Fax:802-527-8187
Practice Address - Street 1:11 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9701
Practice Address - Country:US
Practice Address - Phone:802-527-8189
Practice Address - Fax:802-527-8187
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200036462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4382Medicaid
VT4382OtherBLUE CROSS BLUE SHIELD