Provider Demographics
NPI:1033158597
Name:HOOVER, CHARLES H III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:HOOVER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-289-8427
Mailing Address - Fax:704-283-5522
Practice Address - Street 1:1420 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5160
Practice Address - Country:US
Practice Address - Phone:704-289-8427
Practice Address - Fax:704-283-5522
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC21800207RA0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC43650OtherBCBS
SCN12800Medicaid
NC8943650Medicaid
AH9013296OtherDEA
AH9013296OtherDEA
C84570Medicare UPIN
NC207370DMedicare PIN
NC8943650Medicaid