Provider Demographics
NPI:1902806235
Name:HOFFMAN, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRL STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-896-8383
Mailing Address - Fax:919-896-8387
Practice Address - Street 1:4201 LAKE BOONE TRL STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-896-8383
Practice Address - Fax:919-896-8387
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8942823Medicaid
NCE07606Medicare UPIN
NC8942823Medicaid