Provider Demographics
NPI:1073869723
Name:HOFFMAN, SUSAN VIRGINIA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VIRGINIA
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 1:132 STATION RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:ME
Mailing Address - Zip Code:04434
Mailing Address - Country:US
Mailing Address - Phone:207-269-2816
Mailing Address - Fax:207-269-2816
Practice Address - Street 1:132 STATION RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:ME
Practice Address - Zip Code:04434
Practice Address - Country:US
Practice Address - Phone:207-269-2816
Practice Address - Fax:207-269-2816
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies