Healthcare Provider Details

I. General information

NPI: 1588139737
Provider Name (Legal Business Name): TARAH HOFFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 ALEWIFE BROOK PKWY # 1065
CAMBRIDGE MA
02138-1121
US

IV. Provider business mailing address

186 ALEWIFE BROOK PKWY # 1065
CAMBRIDGE MA
02138-1121
US

V. Phone/Fax

Practice location:
  • Phone: 508-319-9537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005310
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: