Provider Demographics
NPI:1033199708
Name:HOTCHKISS, JEROME J JR (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:J
Last Name:HOTCHKISS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:
Practice Address - Street 1:24 GLOUCESTER RD
Practice Address - Street 2:
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477-3321
Practice Address - Country:US
Practice Address - Phone:540-337-3710
Practice Address - Fax:540-337-0930
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6447399OtherCIGNA
VA1000870001OtherDME PROVIDER
VA3810009610OtherWV MEDICAID
VA302939OtherANTHEM
VA638329OtherSOUTHERN HEALTH
VA30680OtherOPTIMA
VA1033199708Medicaid
VA638329OtherSOUTHERN HEALTH
VA3810009610OtherWV MEDICAID