Provider Demographics
NPI:1205806742
Name:HOFFMAN-MARINO, MANDOLIN DEBORAH (PA-C)
Entity type:Individual
Prefix:
First Name:MANDOLIN
Middle Name:DEBORAH
Last Name:HOFFMAN-MARINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-4509
Mailing Address - Country:US
Mailing Address - Phone:681-342-3660
Mailing Address - Fax:
Practice Address - Street 1:135 PROFESSIONAL PLACE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:681-342-3660
Practice Address - Fax:681-342-3598
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant