Individual
MR. EDMUND W HOOVEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2435 W BELVEDERE AVE, SUITE 35, BALTIMORE, MD 21215-5224
(410) 601-0900
(410) 601-0901
Mailing address
2401 W BELVEDERE AVE, ATTN: CREDENTIALING, BALTIMORE, MD 21215-5216
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C0001399
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA8374
R/R MEDICARE GROUP #
MD
01
—
P00236585
R/R MEDICARE PROVIDER #
MD
Enumeration date
06/02/2006
Last updated
11/29/2007
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