MEDICARE: SUSAN VIRGINIA HOFFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1073869723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN VIRGINIA HOFFMAN

Provider Business Mailing Address
First Line	:	132 STATION RD
Second Line	:
City	:	ETNA
State	:	ME
Zip	:	04434
Country	:	US
Telephone Number	:	207-269-2816
Fax Number	:	207-269-2816

Provider Business Practice Location Address
First Line	:	132 STATION RD
Second Line	:
City	:	ETNA
State	:	ME
Zip	:	04434
Country	:	US
Telephone Number	:	207-269-2816
Fax Number	:	207-269-2816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/31/2012

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Directions to “ SUSAN VIRGINIA HOFFMAN ” Practice Location

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