Provider Demographics
NPI:1861492233
Name:HOLMAN, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:901 ENTERPRISE PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2499
Mailing Address - Country:US
Mailing Address - Phone:757-826-5437
Mailing Address - Fax:757-826-5794
Practice Address - Street 1:901 ENTERPRISE PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2499
Practice Address - Country:US
Practice Address - Phone:757-826-5437
Practice Address - Fax:757-826-5794
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101045706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006769357Medicaid
VA541663494OtherCHAMPUS
VA541663494OtherCHAMPUS