Provider Demographics
NPI:1043444573
Name:HOOVER, DERRICK JOHN (MD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:JOHN
Last Name:HOOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:495 FLATBUSH AVE STE C5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276-280 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1659
Practice Address - Country:US
Practice Address - Phone:607-722-2769
Practice Address - Fax:607-772-2095
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC217329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2016-00777OtherNORTH CAROLINA MEDICAL BOARD LICENSE
NCFH2665466OtherDEA LICENSE
NCFH2665466OtherDEA LICENSE