Provider Demographics
NPI:1366631038
Name:SHELLEY K. HOOVER, M.D., PC
Entity Type:Organization
Organization Name:SHELLEY K. HOOVER, M.D., PC
Other - Org Name:AFFILIATED DERMATOLOGISTS OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-264-4545
Mailing Address - Street 1:8600 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2719
Mailing Address - Country:US
Mailing Address - Phone:804-264-4262
Mailing Address - Fax:804-264-4260
Practice Address - Street 1:8600 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2719
Practice Address - Country:US
Practice Address - Phone:804-264-4262
Practice Address - Fax:804-264-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-053613207N00000X
VA0101-334798207N00000X
VA0101-239915207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO8598Medicare PIN