Provider Demographics
NPI:1891930624
Name:HOLMAN, KATHERINE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:HOLMAN
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 1:9500 EUCLID AVE # G21
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-636-1873
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # G21
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-636-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD29542207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051119892OtherBCBS
AL131118Medicaid
AL131255Medicaid
AL051119890OtherBCBS
AL051119891OtherBCBS
MS04287211Medicaid
AL131250Medicaid
AL051119767OtherBCBS
ALZ21037OtherVIVA
AL131252Medicaid
AL051119768OtherBCBS
AL131257Medicaid
ALZ21037OtherVIVA
AL051119890OtherBCBS