Healthcare Provider Details

I. General information

NPI: 1871544783
Provider Name (Legal Business Name): GLENN HOFFMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PARK ST
HYANNIS MA
02601-5230
US

IV. Provider business mailing address

12 GILL ST STE 3000
WOBURN MA
01801-1728
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-5981
  • Fax:
Mailing address:
  • Phone: 781-937-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA501
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: