=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598761835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY T HOFMANN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 WOODLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19104-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-823-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1245 HIGHLAND AVE STE 302
-----------------------------------------------------
City | ABINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19001-3724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-517-8850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | MD041915-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------