Healthcare Provider Details

I. General information

NPI: 1366814972
Provider Name (Legal Business Name): MATTHEW PETER HOFFMANN JR. CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 CROWN MILL DR
MOHRSVILLE PA
19541-9403
US

IV. Provider business mailing address

PO BOX 121
MOHRSVILLE PA
19541-0121
US

V. Phone/Fax

Practice location:
  • Phone: 484-332-4532
  • Fax:
Mailing address:
  • Phone: 484-332-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: