Healthcare Provider Details

I. General information

NPI: 1548253818
Provider Name (Legal Business Name): JOSEPH HOFFMAN AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

9336 E BAYSHORE RD
MARBLEHEAD OH
43440-2414
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7330
  • Fax:
Mailing address:
  • Phone: 216-509-3993
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67000064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: