Healthcare Provider Details

I. General information

NPI: 1467440768
Provider Name (Legal Business Name): EDWARD THOMAS HOVICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 MAIN ST STE 204
PHOENIXVILLE PA
19460-4478
US

IV. Provider business mailing address

824 MAIN ST STE 204
PHOENIXVILLE PA
19460-4478
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-1175
  • Fax: 610-983-3903
Mailing address:
  • Phone: 610-649-1175
  • Fax: 610-983-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD043801L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: