Healthcare Provider Details

I. General information

NPI: 1396991683
Provider Name (Legal Business Name): CHARLES JACOBS HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ARMORY DR
FRANKLIN VA
23851-2419
US

IV. Provider business mailing address

2000 MEADE PKWY
SUFFOLK VA
23434-4259
US

V. Phone/Fax

Practice location:
  • Phone: 757-562-0085
  • Fax: 757-516-8230
Mailing address:
  • Phone: 757-539-0251
  • Fax: 757-923-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101019476
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: