Healthcare Provider Details

I. General information

NPI: 1366631038
Provider Name (Legal Business Name): SHELLEY K. HOOVER, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 STAPLES MILL RD
RICHMOND VA
23228-2719
US

IV. Provider business mailing address

8600 STAPLES MILL RD
RICHMOND VA
23228-2719
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-4262
  • Fax: 804-264-4260
Mailing address:
  • Phone: 804-264-4262
  • Fax: 804-264-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101-334798
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101-239915
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101-053613
License Number StateVA

VIII. Authorized Official

Name: SHELLEY K HOOVER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-264-4545