Healthcare Provider Details

I. General information

NPI: 1396942769
Provider Name (Legal Business Name): MELISSA HOFMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH STREET AND CIVIC CENTER BLVD THE CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104-3309
US

IV. Provider business mailing address

3535 MARKET ST
PHILADELPHIA PA
19104-3309
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 215-590-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT188045
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD434702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: