Healthcare Provider Details

I. General information

NPI: 1841518123
Provider Name (Legal Business Name): THERESA JANE KAUFMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 TOWNSHIP LINE ROAD SUITE 150
YARDLEY PA
19067-5567
US

IV. Provider business mailing address

491 ALLENDALE ROAD SUITE 104
KING OF PRUSSIA PA
19406-1430
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-3360
  • Fax: 215-860-3362
Mailing address:
  • Phone: 215-860-3360
  • Fax: 215-860-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MB10331400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS017554
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier103128792
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: