Individual
MARY HOLTHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
122 DEFENSE HWY STE 210, ANNAPOLIS, MD 21401-7071
(410) 266-9694
Mailing address
122 DEFENSE HWY STE 210, ANNAPOLIS, MD 21401-7071
(240) 205-5832
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C07349
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C07349
MARYLAND BOARD OF PHYSICIANS
MD
Enumeration date
07/02/2019
Last updated
01/19/2023
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