Provider Demographics
NPI:1881971570
Name:HOLLOWAY, ISAIAH LAMONE I
Entity type:Individual
Prefix:MR
First Name:ISAIAH
Middle Name:LAMONE
Last Name:HOLLOWAY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 JEROME RD
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2311
Mailing Address - Country:US
Mailing Address - Phone:860-892-8127
Mailing Address - Fax:
Practice Address - Street 1:43 JEROME RD
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2311
Practice Address - Country:US
Practice Address - Phone:860-892-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program