Healthcare Provider Details

I. General information

NPI: 1093951634
Provider Name (Legal Business Name): MARK ALAN HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2009
Last Update Date: 01/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LOCUST ST UNIT #1000
PHILADELPHIA PA
19102-3726
US

IV. Provider business mailing address

1515 LOCUST ST UNIT #1000
PHILADELPHIA PA
19102-3726
US

V. Phone/Fax

Practice location:
  • Phone: 215-985-2729
  • Fax:
Mailing address:
  • Phone: 215-985-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-044448L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: