1063616555 NPI number — DR. AMANDA BROOKE HOOPER MD

Table of content: DR. AMANDA BROOKE HOOPER MD (NPI 1063616555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063616555 NPI number — DR. AMANDA BROOKE HOOPER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPER
Provider First Name:
AMANDA
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
AMANDA
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063616555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23501-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-446-8920
Provider Business Mailing Address Fax Number:
757-446-5242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 FAIRFAX AVE
Provider Second Line Business Practice Location Address:
SUITE 445
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23507-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-446-8920
Provider Business Practice Location Address Fax Number:
757-446-5242
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101260666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063616555 . This is a "CORVEL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "HUMANA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "VIRGINIA PREMIER HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1063616555 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063616555 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063616555 . This is a "USA MANGED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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