Provider Demographics
NPI:1487937736
Name:HOLCOMB, KINGSTON RASHID (LMT)
Entity type:Individual
Prefix:MR
First Name:KINGSTON
Middle Name:RASHID
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 JODY KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2946
Mailing Address - Country:US
Mailing Address - Phone:240-855-6134
Mailing Address - Fax:
Practice Address - Street 1:5310 OLD COURT RD
Practice Address - Street 2:SUITE 308
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5243
Practice Address - Country:US
Practice Address - Phone:410-635-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist