Provider Demographics
NPI:1518951573
Name:HOLLOWAY, THOMAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 SAND RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4493
Mailing Address - Country:US
Mailing Address - Phone:419-352-4065
Mailing Address - Fax:419-352-4065
Practice Address - Street 1:199 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1490
Practice Address - Country:US
Practice Address - Phone:419-342-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049753207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0585933Medicaid
000000501096OtherANTHEM
P00080101OtherRAILROAD MEDICARE
P00080101OtherRAILROAD MEDICARE
OHHO7318051Medicare ID - Type Unspecified