Provider Demographics
NPI:1174581516
Name:HOLMES, GREGORY L (MD)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:149 BEAUMONT AVENUE
Mailing Address - Street 2:HSRF 426
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405
Mailing Address - Country:US
Mailing Address - Phone:802-656-4588
Mailing Address - Fax:802-656-8678
Practice Address - Street 1:111 COLCHER STER AVENUE
Practice Address - Street 2:PATRICK 5-CNL
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-2788
Practice Address - Fax:802-847-5679
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH118302084N0400X, 2084N0402X
VT042-00126372084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006523Medicaid
VT1004503Medicaid
A14260Medicare UPIN
NH30006523Medicaid