Provider Demographics
NPI:1164402970
Name:HOLMES, GREGORY A (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
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 1:316 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21636-1126
Mailing Address - Country:US
Mailing Address - Phone:410-634-2380
Mailing Address - Fax:833-908-2287
Practice Address - Street 1:316 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1126
Practice Address - Country:US
Practice Address - Phone:410-634-2380
Practice Address - Fax:833-908-2287
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19741207Q00000X
DEC10011788207Q00000X
MDD0096355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709560OtherMT. STATE
KY64943137Medicaid
WV000000212536OtherANTHEM
WV00058431OtherRR MEDICARE
OH2444466Medicaid
WV5630043000Medicaid
WV000000212536OtherANTHEM
WV2019576Medicare PIN
WV5630043000Medicaid
WV2019573Medicare PIN
OH2444466Medicaid
WVWV1438AMedicare PIN