Provider Demographics
NPI:1093979130
Name:MARIA HOLMES, MD, PLLC
Entity Type:Organization
Organization Name:MARIA HOLMES, MD, PLLC
Other - Org Name:ISSAQUAH WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CHERNYKH
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-651-4338
Mailing Address - Street 1:4517 SW COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2123
Mailing Address - Country:US
Mailing Address - Phone:425-651-4338
Mailing Address - Fax:425-651-4388
Practice Address - Street 1:22500 SE 64TH PL
Practice Address - Street 2:SUITE 120
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8111
Practice Address - Country:US
Practice Address - Phone:425-651-4338
Practice Address - Fax:425-651-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037841207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8245193Medicaid
WAAB11489Medicare PIN
WA8245193Medicaid