Healthcare Provider Details

I. General information

NPI: 1194798785
Provider Name (Legal Business Name): LEWIS HOFMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WHITE HOUSE MEDICAL UNIT THE WHITE HOUSE
WASHINGTON DC
20502-0001
US

IV. Provider business mailing address

2427 KEMPER RD
CROFTON MD
21114-2552
US

V. Phone/Fax

Practice location:
  • Phone: 202-757-2476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-043-647-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: