Provider Demographics
NPI:1548262462
Name:STANLEY, HOLLY LYN (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LYN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-893-8627
Mailing Address - Fax:804-673-5497
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-893-8627
Practice Address - Fax:804-673-5497
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-034744207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VAF45699Medicare UPIN