Provider Demographics
NPI:1548247380
Name:HOFFMAN, LARRY K (DO)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 ROYALTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7171 ROYALTON RD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4818
Practice Address - Country:US
Practice Address - Phone:440-816-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0004078307OtherAETNA
OH0843940002OtherDMERC
OH000000198462OtherANTHEM PIN
OH0681007Medicaid
OH3416527556P00OtherANTHEM GROUP
OH2238199Medicaid
OH54279OtherHIGHMARK
OH61280OtherQUAL CHOICE
OH080163399OtherRAILROAD MEDICARE
OH61280OtherQUAL CHOICE
OHHO0612835Medicare PIN