Provider Demographics
NPI:1649368549
Name:HOFSTETTER, GREGORY (PHED)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HOFSTETTER
Suffix:
Gender:M
Credentials:PHED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9474 VIEWCREST DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1942
Mailing Address - Country:US
Mailing Address - Phone:412-366-4933
Mailing Address - Fax:
Practice Address - Street 1:176 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1723
Practice Address - Country:US
Practice Address - Phone:724-775-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003913L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist