Provider Demographics
NPI:1629181185
Name:MOHR, HOLLY ANN (MSRN PNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:MOHR
Suffix:
Gender:F
Credentials:MSRN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAYO RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2951
Mailing Address - Country:US
Mailing Address - Phone:410-956-6303
Mailing Address - Fax:410-956-6637
Practice Address - Street 1:224 MAYO RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2951
Practice Address - Country:US
Practice Address - Phone:410-956-6303
Practice Address - Fax:410-956-6637
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics