Provider Demographics
NPI:1215994546
Name:HOLMES, GRACE D (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:D
Last Name:HOLMES
Suffix:
Gender:F
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:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:607-336-6362
Mailing Address - Fax:607-336-2028
Practice Address - Street 1:55 CALVARY DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1032
Practice Address - Country:US
Practice Address - Phone:607-336-6362
Practice Address - Fax:607-336-2028
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013496Medicaid
NYD02330Medicare UPIN
NY01013496Medicaid