Healthcare Provider Details

I. General information

NPI: 1922035617
Provider Name (Legal Business Name): MARTIN G HOFFMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 3212
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

2525 W UNIVERSITY AVE
MUNCIE IN
47303-3421
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-1171
  • Fax: 860-493-6524
Mailing address:
  • Phone: 765-289-5408
  • Fax: 765-254-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberLT4211
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number041459
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number02006081A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number041459
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: