Provider Demographics
NPI:1871538835
Name:HOFFMAN, NEAL T (PA)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:T
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 N GREEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8705
Practice Address - Country:US
Practice Address - Phone:317-852-2251
Practice Address - Fax:317-852-1225
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN521070LLMedicare ID - Type Unspecified
INM400022569Medicare PIN
IN221900CMedicare ID - Type Unspecified
INP01014250Medicare PIN
INS48067Medicare UPIN
IN345630GMedicare ID - Type Unspecified