Provider Demographics
NPI:1396991683
Name:HOFFMAN, CHARLES JACOBS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JACOBS
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEADE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4259
Mailing Address - Country:US
Mailing Address - Phone:757-539-0251
Mailing Address - Fax:757-923-9610
Practice Address - Street 1:1301 ARMORY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2419
Practice Address - Country:US
Practice Address - Phone:757-562-0085
Practice Address - Fax:757-516-8230
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396991683Medicaid
NC890676JMedicaid
VAB07514Medicare UPIN
VA018720L76Medicare PIN