Provider Demographics
NPI:1487778163
Name:HOFFMAN, ELISSA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:JANE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:95 MARION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5667
Mailing Address - Country:US
Mailing Address - Phone:304-284-8955
Mailing Address - Fax:304-284-0059
Practice Address - Street 1:3 CROSSWINDS DR
Practice Address - Street 2:YOUTH ACADEMY, LLC
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9193
Practice Address - Country:US
Practice Address - Phone:304-363-3341
Practice Address - Fax:304-363-3342
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV179832084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE76842Medicare UPIN
WV6030532Medicare PIN