Provider Demographics
NPI:1760572457
Name:HOLLAND, AGNES E (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:E
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3015 WILLIAMS DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-641-9133
Mailing Address - Fax:703-280-5098
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:STE 50
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-564-1053
Practice Address - Fax:703-280-5098
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012405012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00376889OtherRR MEDICARE
VA1760572457Medicaid
VA10011034OtherSENTARA
NC5905226Medicaid
VA10011034OtherOPTIMA
VA139178OtherBCBS
VAP00376889OtherRR MEDICARE
VA011829M13Medicare PIN