Provider Demographics
NPI:1992790406
Name:HOLWICK, JANN L (MD)
Entity type:Individual
Prefix:MS
First Name:JANN
Middle Name:L
Last Name:HOLWICK
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 1:668 BEETHOVEN LANE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24991
Mailing Address - Country:US
Mailing Address - Phone:304-645-2797
Mailing Address - Fax:
Practice Address - Street 1:1095 N. FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:304-647-0677
Practice Address - Fax:309-758-5035
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010148833208600000X
VA0101048833207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010042470Medicaid
VAA45880Medicare UPIN
VA00V901A01Medicare ID - Type Unspecified