Provider Demographics
NPI:1336279215
Name:DUSHKIN, HOLLY (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DUSHKIN
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 1:25 MAIN ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7083
Mailing Address - Country:US
Mailing Address - Phone:201-510-0910
Mailing Address - Fax:201-621-6931
Practice Address - Street 1:5454 WISCONSIN AVE STE 1300
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6908
Practice Address - Country:US
Practice Address - Phone:301-657-4588
Practice Address - Fax:301-657-9566
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH120274207RX0202X
PAMD422804207RX0202X
DCMD044842207RX0202X
MDD0065635207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022237140001Medicaid
MD1P8162OtherMEDICARE
MD413316100Medicaid
OH00745574Medicaid