Provider Demographics
NPI:1275567323
Name:CHRISTMAN, HOLLY LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LOUISE
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 MARINSHIP WAY STE 370
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2853
Mailing Address - Country:US
Mailing Address - Phone:415-887-9758
Mailing Address - Fax:415-887-9763
Practice Address - Street 1:2330 MARINSHIP WAY STE 370
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965
Practice Address - Country:US
Practice Address - Phone:415-887-9758
Practice Address - Fax:415-887-9763
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56005207N00000X, 207ND0900X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF38331Medicare UPIN
CA00G560050Medicare ID - Type Unspecified