Provider Demographics
NPI:1720186984
Name:HOOPER, FRED B (DO)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:B
Last Name:HOOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8773
Mailing Address - Country:US
Mailing Address - Phone:717-368-2601
Mailing Address - Fax:
Practice Address - Street 1:1796 3RD AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1913
Practice Address - Country:US
Practice Address - Phone:717-854-2481
Practice Address - Fax:717-854-2442
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 003327 L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35034Medicare UPIN