Provider Demographics
NPI:1144217670
Name:KOFF, AMY BETH (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:KOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:434 ROUTE 134
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-3433
Mailing Address - Country:US
Mailing Address - Phone:508-394-5556
Mailing Address - Fax:508-394-2735
Practice Address - Street 1:434 ROUTE 134
Practice Address - Street 2:UNIT 1A
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3433
Practice Address - Country:US
Practice Address - Phone:508-394-5556
Practice Address - Fax:508-394-2735
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80792207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB20338701OtherCIGNA PROV NO
MAJ16230OtherBLUE CROSS BLUE SHIELD NO
MA4736OtherHARVARD PILGRIM PROV NO
MA070011714OtherRAILROAD MEDICARE PROV NO
MD0300324OtherUNITED HEALTHCARE PROV NO
MA080792OtherTUFTS PROVIDER NO
MAMA0019324OtherCHAMPUSPROVIDER NO.
MASX1817Medicare PIN
MA4736OtherHARVARD PILGRIM PROV NO