Provider Demographics
NPI:1558329144
Name:KOFFMAN, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:KOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W ALAMEDA AVENUE
Mailing Address - Street 2:STE 502
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4816
Mailing Address - Country:US
Mailing Address - Phone:818-843-8022
Mailing Address - Fax:818-843-0721
Practice Address - Street 1:2625 W ALAMEDA AVENUE
Practice Address - Street 2:STE 502
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4816
Practice Address - Country:US
Practice Address - Phone:818-843-8022
Practice Address - Fax:818-843-0721
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19842207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A82128Medicare UPIN
CAA19842Medicare ID - Type Unspecified