Provider Demographics
NPI:1801454715
Name:HOFFMAN, PAMELA ALISE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ALISE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4670
Mailing Address - Country:US
Mailing Address - Phone:614-439-6886
Mailing Address - Fax:
Practice Address - Street 1:7580 AUBURN RD
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-9615
Practice Address - Country:US
Practice Address - Phone:440-352-7546
Practice Address - Fax:440-352-5260
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50.006464RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant