Provider Demographics
NPI:1518200500
Name:DICKMAN, HOLLY (DO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7640 SYLVANIA AVE STE K
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9263
Mailing Address - Country:US
Mailing Address - Phone:419-517-1004
Mailing Address - Fax:419-517-1021
Practice Address - Street 1:7640 SYLVANIA AVE STE K
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9263
Practice Address - Country:US
Practice Address - Phone:419-517-1004
Practice Address - Fax:419-517-1021
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine