Provider Demographics
NPI:1699762450
Name:HOFFMAN, MARY P (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5052
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN212010L163W00000X
PA039844367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11783676OtherCAQH
PA1343425OtherFIRST PRIORITY
PA1543033OtherGATEWAY
PA82592OtherGEISINGER
PA03223101OtherCAPITAL ADVANTAGE
PA1027807540001Medicaid
PA1343425OtherKHP CENTRAL
PA9997436OtherAETNA
PA1343425OtherHIGHMARK
PA2036074000OtherINDEP. BLUE CROSS
PA1343425OtherFIRST PRIORITY
PAS48189Medicare UPIN
PA1027807540001Medicaid