Healthcare Provider Details

I. General information

NPI: 1992788012
Provider Name (Legal Business Name): SUSAN M KAUFMAN DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 YORK ST SUITE B
CORRY PA
16407-1420
US

IV. Provider business mailing address

300 YORK ST SUITE B
CORRY PA
16407-1420
US

V. Phone/Fax

Practice location:
  • Phone: 814-664-3979
  • Fax: 814-663-4879
Mailing address:
  • Phone: 814-664-3979
  • Fax: 814-663-4879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006866L
License Number StatePA

VIII. Authorized Official

Name: MR. BRUCE KAUFMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 814-664-3979