Provider Demographics
NPI:1578568812
Name:HOLLAND, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 80TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3427
Mailing Address - Country:US
Mailing Address - Phone:360-659-1231
Mailing Address - Fax:360-659-7267
Practice Address - Street 1:4404 80TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3427
Practice Address - Country:US
Practice Address - Phone:360-659-1231
Practice Address - Fax:360-659-7267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00022786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005297Medicaid
WA1005297Medicaid
WAAB20838Medicare ID - Type Unspecified