Healthcare Provider Details

I. General information

NPI: 1962647842
Provider Name (Legal Business Name): PAMELA EDIE HOFFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S FRONTAGE RD # G112
NEW HAVEN CT
06519-1124
US

IV. Provider business mailing address

230 S FRONTAGE RD # G112
NEW HAVEN CT
06519-1124
US

V. Phone/Fax

Practice location:
  • Phone: 347-688-7796
  • Fax:
Mailing address:
  • Phone: 347-688-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number53080
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD15405
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number53080
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: