Healthcare Provider Details

I. General information

NPI: 1134171119
Provider Name (Legal Business Name): JULIE HOOVER-FONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JULIE HOOVER

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64316
BALTIMORE MD
21264-4316
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD57914
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberD57914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: