Provider Demographics
NPI:1952441842
Name:HOLMES, ALLEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:J
Last Name:HOLMES
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 1:265 RACINE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8745
Mailing Address - Country:US
Mailing Address - Phone:910-399-6661
Mailing Address - Fax:
Practice Address - Street 1:265 RACINE DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8745
Practice Address - Country:US
Practice Address - Phone:910-399-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22253207P00000X
NC200500319207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952441842OtherCHAMPUS
NC5900923Medicaid
KY7100040000Medicaid
WVP00387855OtherMEDICARE-RR PROVIDER NUMBER
OH2795855Medicaid
WV1952441842Medicaid
NCP01165075OtherRAILROAD MEDICARE
NCNC4688CMedicare PIN