Provider Demographics
NPI:1457496614
Name:ELWOOD S. HOLLAND, M.D., P.A.
Entity Type:Organization
Organization Name:ELWOOD S. HOLLAND, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-341-1177
Mailing Address - Street 1:6005 LANDOVER RD
Mailing Address - Street 2:STE. 3
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1145
Mailing Address - Country:US
Mailing Address - Phone:301-341-1177
Mailing Address - Fax:301-341-5659
Practice Address - Street 1:6005 LANDOVER RD
Practice Address - Street 2:STE. 3
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1145
Practice Address - Country:US
Practice Address - Phone:301-341-1177
Practice Address - Fax:301-341-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:2009-03-24
Deactivation Code:
Reactivation Date:2015-09-04
Provider Licenses
StateLicense IDTaxonomies
MDD20989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0795OtherBCBSNCA
MD188621500Medicaid
DC080187474OtherRAILROAD MEDICARE PROVIDE
2107922OtherAETNA,INS.
MD4296OtherBCBS(CAREFIRST)
MD4296OtherBCBS(CAREFIRST)
MD4296OtherBCBS(CAREFIRST)
DC410059Medicare PIN