Provider Demographics
NPI:1174731962
Name:HOFFER, KELLY D (IDC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:D
Last Name:HOFFER
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 MASON NECK LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8761
Mailing Address - Country:US
Mailing Address - Phone:757-445-9034
Mailing Address - Fax:
Practice Address - Street 1:1084 POCAHONTAS ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2133
Practice Address - Country:US
Practice Address - Phone:757-445-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians