Healthcare Provider Details

I. General information

NPI: 1366402059
Provider Name (Legal Business Name): DAVID A KAUFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST
WORCESTER MA
01608-1200
US

IV. Provider business mailing address

123 SUMMER ST
WORCESTER MA
01608-1200
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-9222
  • Fax: 508-363-9268
Mailing address:
  • Phone: 508-363-9222
  • Fax: 508-363-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number59853
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3038050
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: