Healthcare Provider Details

I. General information

NPI: 1205819521
Provider Name (Legal Business Name): SCOTT KAUFMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MILFORD ST STE 605
SALISBURY MD
21804-6952
US

IV. Provider business mailing address

105 MILFORD ST STE 605
SALISBURY MD
21804-6952
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-2227
  • Fax:
Mailing address:
  • Phone: 410-334-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number02001632A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberH93578
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: