Provider Demographics
NPI:1306342712
Name:HOLLOWAY, TERRELL DAVID (MD)
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:DAVID
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 WHEELERS FARMS RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-9109
Mailing Address - Country:US
Mailing Address - Phone:631-355-3366
Mailing Address - Fax:
Practice Address - Street 1:472 WHEELERS FARMS RD STE 306
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-9109
Practice Address - Country:US
Practice Address - Phone:203-701-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT701022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty