Provider Demographics
NPI:1386683613
Name:HOOVER, HERBERT C JR (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:C
Last Name:HOOVER
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 1:804 GRANDVIEW DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1681
Mailing Address - Country:US
Mailing Address - Phone:717-466-2500
Mailing Address - Fax:
Practice Address - Street 1:804 GRANDVIEW DR
Practice Address - Street 2:WELLSPAN SURGICAL SPECIALISTS
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522
Practice Address - Country:US
Practice Address - Phone:717-466-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064871A208600000X
PAMD055401L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015088420006Medicaid
GAB76087Medicare UPIN
PAP01589049Medicare PIN
PA443680FLTMedicare PIN
PA443680Medicare PIN