Provider Demographics
NPI:1922622406
Name:HOWARD, HOLLY CAMILLE (DO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CAMILLE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOLBROOK ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1760
Mailing Address - Country:US
Mailing Address - Phone:434-792-7765
Mailing Address - Fax:434-793-4061
Practice Address - Street 1:101 HOLBROOK ST STE 2
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1760
Practice Address - Country:US
Practice Address - Phone:434-792-7765
Practice Address - Fax:434-793-4061
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102208030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program