Healthcare Provider Details

I. General information

NPI: 1255395786
Provider Name (Legal Business Name): THEODORE J. HOVICK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 6TH AVE
ALTOONA PA
16602-1917
US

IV. Provider business mailing address

2 HOT METAL ST STE N357
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 814-889-2626
  • Fax: 814-889-3197
Mailing address:
  • Phone: 412-432-5868
  • Fax: 412-647-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD064017L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: