Provider Demographics
NPI:1548373525
Name:HOFFERT, MARVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:J
Last Name:HOFFERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 SCHAUB DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1862
Mailing Address - Country:US
Mailing Address - Phone:919-834-2000
Mailing Address - Fax:919-834-2001
Practice Address - Street 1:1011 SCHAUB DR
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1862
Practice Address - Country:US
Practice Address - Phone:919-834-2000
Practice Address - Fax:919-834-2001
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-001952084P0800X, 2084A0401X, 2084B0040X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1103043Medicaid
WAH01213OtherBLUE SHEILD
WA0117818OtherWORKER'S COMP/ DEPT L & I
NC5915816Medicaid
WA1103043Medicaid
NC22076405Medicare PIN
WAG8877249Medicare PIN