Provider Demographics
NPI:1780063636
Name:HOLLAND, ANDREA CLAIR (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CLAIR
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CLAIR
Other - Last Name:GIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:
Practice Address - Street 1:8101 E LOWRY BLVD STE 255
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7121
Practice Address - Country:US
Practice Address - Phone:720-321-3581
Practice Address - Fax:720-321-3582
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00235207Q00000X
KY53606207Q00000X
CODR.0067941207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine