Healthcare Provider Details

I. General information

NPI: 1902806235
Provider Name (Legal Business Name): SCOTT DAVID HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL STE 102
RALEIGH NC
27607
US

IV. Provider business mailing address

4201 LAKE BOONE TRL STE 102
RALEIGH NC
27607-7511
US

V. Phone/Fax

Practice location:
  • Phone: 919-896-8383
  • Fax: 919-896-8387
Mailing address:
  • Phone: 919-896-8383
  • Fax: 919-896-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: