Provider Demographics
NPI:1326099557
Name:JOSEPH B HOLLIS MD PC
Entity Type:Organization
Organization Name:JOSEPH B HOLLIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-397-2493
Mailing Address - Street 1:1211 RODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3915
Mailing Address - Country:US
Mailing Address - Phone:757-397-2493
Mailing Address - Fax:757-397-7189
Practice Address - Street 1:1211 RODMAN AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3915
Practice Address - Country:US
Practice Address - Phone:757-397-2493
Practice Address - Fax:757-397-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028352207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7905835Medicaid
VA011633OtherANTHEM BLUE CROSS BLUE SH
VAC09947Medicare ID - Type Unspecified
VAB06690Medicare UPIN