Provider Demographics
NPI:1548253818
Name:HOFFMAN, JOSEPH (AA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9336 E BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-2414
Mailing Address - Country:US
Mailing Address - Phone:216-509-3993
Mailing Address - Fax:216-464-5982
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67000064367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499621Medicaid
OH000000232165OtherUNISON
OH0583328OtherBCMH
OHP00735176OtherMEDICARE RAILROAD
OH414978OtherWELLCARE MEDICAID
OH5279434OtherAETNA
OH000000515966OtherANTHEM
OH000000515966OtherANTHEM
OHHO8233762Medicare PIN