Provider Demographics
NPI:1740664671
Name:HOLLOMAN, MOOR
Entity type:Individual
Prefix:
First Name:MOOR
Middle Name:
Last Name:HOLLOMAN
Suffix:
Gender:
Credentials:
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 1241
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1241
Mailing Address - Country:US
Mailing Address - Phone:410-603-0504
Mailing Address - Fax:
Practice Address - Street 1:3917 MARKET ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-4413
Practice Address - Country:US
Practice Address - Phone:410-632-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator