Provider Demographics
NPI:1720672280
Name:NORTHWEST HANOVER PHYSICIANS LTD
Entity Type:Organization
Organization Name:NORTHWEST HANOVER PHYSICIANS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-360-1875
Mailing Address - Street 1:5416 HILLSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7143
Mailing Address - Country:US
Mailing Address - Phone:804-360-1875
Mailing Address - Fax:
Practice Address - Street 1:5416 HILLSHIRE WAY
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7143
Practice Address - Country:US
Practice Address - Phone:804-360-1875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service