Provider Demographics
NPI:1417922394
Name:HOFFMAN, TIMOTHY J (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848
Mailing Address - Country:US
Mailing Address - Phone:570-268-4096
Mailing Address - Fax:570-265-7824
Practice Address - Street 1:380 YORK AVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-268-4096
Practice Address - Fax:570-265-7824
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009627L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017489560005Medicaid
G88097Medicare UPIN
PA0017489560005Medicaid
PA024705NACMedicare PIN