Provider Demographics
NPI:1285950816
Name:HOFFMAN, DESPINA E (DO)
Entity type:Individual
Prefix:
First Name:DESPINA
Middle Name:E
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0366
Mailing Address - Country:US
Mailing Address - Phone:413-773-5797
Mailing Address - Fax:413-417-2978
Practice Address - Street 1:115 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1215
Practice Address - Country:US
Practice Address - Phone:413-773-5797
Practice Address - Fax:413-773-9009
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277445207RN0300X, 207RN0300X
CA20A14939207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201288940Medicaid
IN201288940Medicaid