Provider Demographics
NPI:1356544365
Name:ROBERT M HOLLEY MD, INC
Entity type:Organization
Organization Name:ROBERT M HOLLEY MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-675-1675
Mailing Address - Street 1:2500 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1530
Mailing Address - Country:US
Mailing Address - Phone:304-675-1675
Mailing Address - Fax:304-675-3713
Practice Address - Street 1:2500 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1530
Practice Address - Country:US
Practice Address - Phone:304-675-1675
Practice Address - Fax:304-675-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========OtherCOMMERICAL
WV=========OtherCOMMERICAL