Provider Demographics
NPI:1851382980
Name:BROWN, HOLLY CONWAY (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CONWAY
Last Name:BROWN
Suffix:
Gender:F
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:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:3500 MOUNT VERNON RD SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-3864
Practice Address - Country:US
Practice Address - Phone:319-366-6249
Practice Address - Fax:319-366-6244
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33765207K00000X
IAMD-33765207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI9466OtherMEDICARE PTAN
IA1851382980Medicaid
IAI9466Medicare PIN