Healthcare Provider Details

I. General information

NPI: 1245371772
Provider Name (Legal Business Name): HANOVER PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 SLIDING HILL RD
ASHLAND VA
23005-7953
US

IV. Provider business mailing address

10035 SLIDING HILL RD
ASHLAND VA
23005-7953
US

V. Phone/Fax

Practice location:
  • Phone: 804-550-7800
  • Fax: 804-550-7904
Mailing address:
  • Phone: 804-550-7800
  • Fax: 804-550-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101050409
License Number StateVA

VIII. Authorized Official

Name: CAROL B WILLIAMS
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 804-550-7800