Basic Information
| Provider Information | |||||||||
| NPI: | 1548373525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFERT | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 SCHAUB DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276061862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198342000 | ||||||||
| FaxNumber: | 9198342001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 SCHAUB DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276061862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198342000 | ||||||||
| FaxNumber: | 9198342001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 04/11/2014 | ||||||||
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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 | 2084P0800X | 2010-00195 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084A0401X | 2010-00195 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084B0040X | 2010-00195 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 2084P2900X | 2010-00195 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1103043 | 05 | WA | MEDICAID | H01213 | 01 | WA | BLUE SHEILD | OTHER | 0117818 | 01 | WA | WORKER'S COMP/ DEPT L & I | OTHER | 5915816 | 05 | NC | MEDICAID |