Provider Demographics
NPI:1215991575
Name:KAUFMAN, RICHARD ENOCH (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ENOCH
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3730
Mailing Address - Country:US
Mailing Address - Phone:203-488-6358
Mailing Address - Fax:203-481-5327
Practice Address - Street 1:960 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3730
Practice Address - Country:US
Practice Address - Phone:203-488-6358
Practice Address - Fax:203-481-5327
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017295207K00000X
CT17295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110211648OtherRAILROAD MEDICARE
2330377OtherAETNA-SPECIALIST
731524OtherCONNECTICARE
1051462OtherAETNA-PCP
010017295CT01OtherANTHEM BCBS
OXFORDOtherP382354
CT001172956Medicaid
0Q1750OtherHEALTHNET