Provider Demographics
NPI:1932376100
Name:MARYLAND HOLISTIC HEALTHCARE, P.C.
Entity type:Organization
Organization Name:MARYLAND HOLISTIC HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JOCELYN ADRIENNE
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-300-8461
Mailing Address - Street 1:10307 W BROAD ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6716
Mailing Address - Country:US
Mailing Address - Phone:301-560-1750
Mailing Address - Fax:301-560-6322
Practice Address - Street 1:5115 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7056
Practice Address - Country:US
Practice Address - Phone:301-560-1750
Practice Address - Fax:301-560-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0061034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty