MEDICARE: JOHN DAVID HOOVER MD

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	2080P0203X	Pediatric Critical Care Medicine Physician	200501045	NC
2	2086S0120X	Pediatric Surgery Physician	2005-01045	NC
3	208600000X	Surgery Physician	2005-01045	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7878267	OTHER	NC	AETNA
3	145GH	OTHER	NC	BCBS OF NC
4	197896	OTHER	NC	MEDCOST
5	5596858	OTHER	NC	CIGNA

General Provider Information

NPI Number	:	1700857869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID HOOVER MD

Provider Business Mailing Address
First Line	:	PO BOX 603949
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3949
Country	:	US
Telephone Number	:	919-350-0351
Fax Number	:	919-350-7687

Provider Business Practice Location Address
First Line	:	23 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1855
Country	:	US
Telephone Number	:	919-350-8797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/17/2023

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Directions to “ JOHN DAVID HOOVER MD” Practice Location

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