Provider Demographics
NPI:1770698078
Name:HOLLAND, MAUREEN (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:JMM SUITE 2525
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-9528
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:8950 LORRAINE RD STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4183
Practice Address - Country:US
Practice Address - Phone:228-396-3238
Practice Address - Fax:601-496-8103
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114913Medicaid
MS$$$$$$$$$EOtherBCBS
MS$$$$$$$$$FOtherBCBS
MS00114913Medicaid
MS$$$$$$$$$AOtherBCBS
MS$$$$$$$$$BOtherBCBS
MS$$$$$$$$$GOtherBCBS
MS$$$$$$$$$DOtherBCBS
MS$$$$$$$$$EOtherBCBS