Provider Demographics
NPI:1770551913
Name:HOFFMAN, ROGER A (PAC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 TIMBER GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3099
Mailing Address - Country:US
Mailing Address - Phone:814-322-8072
Mailing Address - Fax:
Practice Address - Street 1:850 OAK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8442
Practice Address - Country:US
Practice Address - Phone:301-698-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q54814Medicare UPIN
PA095444Medicare ID - Type Unspecified