Basic Information
| Provider Information | |||||||||
| NPI: | 1932189644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOVLAND | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 KINGSLEY LN | ||||||||
| Address2: | STE 106 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895735 | ||||||||
| FaxNumber: | 7578895742 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 KINGSLEY LN | ||||||||
| Address2: | STE 106 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895735 | ||||||||
| FaxNumber: | 7578895742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 05/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101026403 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 0101026403 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5859018 | 05 | VA | MEDICAID |