Provider Demographics
NPI:1366470072
Name:HOLLOWAY, KATHRYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:L
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:417 N 11TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5002
Practice Address - Country:US
Practice Address - Phone:804-828-9165
Practice Address - Fax:804-827-0631
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039541207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6100716 - 541581185Medicaid
VAE45101Medicare UPIN
VA6100716 - 541581185Medicaid