Provider Demographics
NPI:1063616555
Name:HOOPER, AMANDA BROOKE (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BROOKE
Last Name:HOOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:BROOKE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260666207R00000X
TNMD0000046903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063616555OtherCORVEL
VA1063616555OtherTRICARE/CHAMPUS
VA1063616555OtherVIRGINIA HEALTH NETWORK
VA1063616555OtherCOVENTRY HEALTH CARE
VA1063616555OtherHUMANA
VA1063616555OtherMULTIPLAN
VA1063616555OtherANTHEM BC/BS
VA1063616555OtherVIRGINIA PREMIER HEALTH PLAN
VA1063616555OtherUNITED HEALTHCARE
VA1063616555OtherOPTIMA HEALTH
VA1063616555OtherCIGNA
VA1063616555OtherAETNA
VA1063616555Medicaid
NC1063616555Medicaid
VA1063616555OtherUSA MANGED CARE
VA1063616555OtherCIGNA
VA1063616555Medicaid