Basic Information
| Provider Information | |||||||||
| NPI: | 1548253818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | AA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9336 E BAYSHORE RD | ||||||||
| Address2: | |||||||||
| City: | MARBLEHEAD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434402414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165093993 | ||||||||
| FaxNumber: | 2164645982 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168447330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 09/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | 67000064 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2499621 | 05 | OH | MEDICAID | 000000232165 | 01 | OH | UNISON | OTHER | 0583328 | 01 | OH | BCMH | OTHER | P00735176 | 01 | OH | MEDICARE RAILROAD | OTHER | 414978 | 01 | OH | WELLCARE MEDICAID | OTHER | 5279434 | 01 | OH | AETNA | OTHER | 000000515966 | 01 | OH | ANTHEM | OTHER |