Provider Demographics
NPI:1184632366
Name:HOLLAND, MEGAN M (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:STORMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:790 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-1755
Mailing Address - Country:US
Mailing Address - Phone:541-396-3111
Mailing Address - Fax:541-396-5891
Practice Address - Street 1:790 E 5TH ST
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1755
Practice Address - Country:US
Practice Address - Phone:541-396-3111
Practice Address - Fax:541-396-5891
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR244094Medicaid
OR244094Medicaid
OR1588684484OtherSOUTHERN COOS HOSPITAL GROUP NPI
OR93-6013768OtherSOUTHERN COOS HOSPITAL TAX ID
OR244094Medicaid
OR276279OtherBANDON RHC MEDICAID
I42267Medicare UPIN
OR244094Medicaid