=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245277441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SETH A KAUFMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 10/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 WASHINGTON STREET, BOX 359 NEW ENGLAND MEDICAL CENTER
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-636-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 KIMBALL ST
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01506-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-636-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 226435
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------