Provider Demographics
NPI:1427784917
Name:HANOVER PEDIATRICS AND ADOLESCENT MEDICINE PC
Entity type:Organization
Organization Name:HANOVER PEDIATRICS AND ADOLESCENT MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-306-8408
Mailing Address - Street 1:3460 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7529
Mailing Address - Country:US
Mailing Address - Phone:804-742-3077
Mailing Address - Fax:
Practice Address - Street 1:3460 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7529
Practice Address - Country:US
Practice Address - Phone:804-742-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty