Provider Demographics
NPI:1407165020
Name:HOHOL, MARY-LAURA (PAC)
Entity Type:Individual
Prefix:
First Name:MARY-LAURA
Middle Name:
Last Name:HOHOL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARY-LAURA
Other - Middle Name:
Other - Last Name:WHELIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 9132
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-9132
Mailing Address - Country:US
Mailing Address - Phone:800-927-0002
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 419
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-737-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant