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General NPI Number Information
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NPI Number | 1427784917
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Entity Type | Organization
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Legal Business Name | HANOVER PEDIATRICS AND ADOLESCENT MEDICINE PC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 3460 LAUDERDALE DR
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City | HENRICO
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State | VA
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Zip | 23233-7529
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Country | US
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Telephone | 804-742-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 3460 LAUDERDALE DR
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City | HENRICO
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State | VA
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Zip | 23233-7529
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Country | US
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Telephone | 804-742-3077
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CAROL A WILLIAMS
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Credential | MD
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Telephone | 804-306-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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