Healthcare Provider Details

I. General information

NPI: 1740654490
Provider Name (Legal Business Name): SARAH KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NORTHCREEK DR
CINCINNATI OH
45236-2377
US

IV. Provider business mailing address

6661 CLYO RD
CENTERVILLE OH
45459-2702
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax:
Mailing address:
  • Phone: 937-425-4000
  • Fax: 937-425-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50004458
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004458RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: