Provider Demographics
NPI:1881809051
Name:HOLWAGER, JAMES KENNEDY (EDD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNEDY
Last Name:HOLWAGER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7217
Mailing Address - Country:US
Mailing Address - Phone:301-777-3074
Mailing Address - Fax:301-729-0804
Practice Address - Street 1:49 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2926
Practice Address - Country:US
Practice Address - Phone:301-777-3074
Practice Address - Fax:301-729-0804
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01260OtherMAGELLAN
MD048020Medicaid
MD52148OtherMAMSI
MD54160OtherAPS
MD22348OtherPHYSICANS CARE
MD048020Medicaid