Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 11830 | NH |
Y | 2084N0402X | Child Neurologist | 042-0012637 | VT |
N | 2084N0402X | Child Neurologist | 11830 | NH |
NPI | 1174581516 |
---|---|
Provider Name | Mr. Gregory L. Holmes |
First Address | Burlington, VT 05405 |
Second Address | Burlington, VT 05401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1004503 | (05) | VT |
30006523 | (05) | NH |
A14260 | (02) |