Healthcare Provider Details

I. General information

NPI: 1093166076
Provider Name (Legal Business Name): BRADLEY HENRY HOFFMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROGERS ST
PRINCETON WV
24740-3636
US

IV. Provider business mailing address

528 SHERIDAN CIR
CHARLESTON WV
25314-1063
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax:
Mailing address:
  • Phone: 814-360-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number10464
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: