Individual
DR. J. DEREK HOLLINGSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6775 POINT PLEASANT RD, MILLWOOD, WV 25262-8100
(304) 273-0112
(304) 273-0115
Mailing address
6775 POINT PLEASANT RD, MILLWOOD, WV 25262-8100
(304) 273-0112
(304) 273-0115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2360
WV
207Q00000X
Family Medicine Physician
34007332
OH
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
27036
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185452
UNISON MEDICAID
OH
01
—
000000205910
ANTHEM BCBS
—
01
—
001714124
MOUNTAIN STATE BCBS
—
01
—
1336192269
NPI
—
01
—
2246895
MOLINA MEDICAID
OH
01
—
27036
STATE LICENSE
MT
05
—
3002978000
—
WV
01
—
516066972
TRI CARE
OH
01
—
930106977
RR MEDICARE
—
Enumeration date
05/19/2006
Last updated
12/19/2016
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