1922035617 NPI number — DR. MARTIN G HOFFMAN D.O.

Table of content: DR. MARTIN G HOFFMAN D.O. (NPI 1922035617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922035617 NPI number — DR. MARTIN G HOFFMAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMAN
Provider First Name:
MARTIN
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922035617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 W UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47303-3421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-289-5408
Provider Business Mailing Address Fax Number:
765-254-3582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ASYLUM AVE
Provider Second Line Business Practice Location Address:
SUITE 3212
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-522-1171
Provider Business Practice Location Address Fax Number:
860-493-6524
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  LT4211 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RT0003X , with the licence number: 041459 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 02006081A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: 041459 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001414599 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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