Provider Demographics
NPI:1770678914
Name:HOLLOWAY, MCDANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MCDANIEL
Middle Name:
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 1:110 CHEMIN PELLETIER SUD
Mailing Address - Street 2:
Mailing Address - City:ST ARMAND
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J0J 1T0
Mailing Address - Country:CA
Mailing Address - Phone:514-448-2427
Mailing Address - Fax:
Practice Address - Street 1:11050 BELEVEDERE BLVD
Practice Address - Street 2:ATTN JILL GOODWIN
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5004
Practice Address - Country:US
Practice Address - Phone:469-524-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047942207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services