Healthcare Provider Details

I. General information

NPI: 1760563043
Provider Name (Legal Business Name): ALISA HOPE HOFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BRAEBURN LN
NARBERTH PA
19072-1504
US

IV. Provider business mailing address

ST CHRISTOPHER'S HOSPITAL FOR CHILDREN ERIE AT FRONT STREET
PHILADELPHIA PA
19134
US

V. Phone/Fax

Practice location:
  • Phone: 205-566-0570
  • Fax:
Mailing address:
  • Phone: 215-427-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD057491L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: