MEDICARE: SHELLEY K. HOOVER, M.D., PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101-334798	VA
2	207N00000X	Dermatology Physician	0101-239915	VA
3	207N00000X	Dermatology Physician	0101-053613	VA

General Provider Information

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

Provider Business Mailing Address
First Line	:	8600 STAPLES MILL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2719
Country	:	US
Telephone Number	:	804-264-4262
Fax Number	:	804-264-4260

Provider Business Practice Location Address
First Line	:	8600 STAPLES MILL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2719
Country	:	US
Telephone Number	:	804-264-4262
Fax Number	:	804-264-4260

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHELLEY K HOOVER
Credential	:	M.D.
Telephone Number	:	804-264-4545

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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