Provider Demographics
NPI:1275677874
Name:HOLTON, MARA R (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:R
Last Name:HOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1001
Mailing Address - Country:US
Mailing Address - Phone:410-246-8049
Mailing Address - Fax:410-266-0895
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-246-8049
Practice Address - Fax:410-266-0895
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-06-12
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Provider Licenses
StateLicense IDTaxonomies
MDD0066009174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist