Provider Demographics
NPI:1326036468
Name:KAUFMAN, CLARK ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ROBERT
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 1:2445 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1942
Mailing Address - Country:US
Mailing Address - Phone:717-393-1365
Mailing Address - Fax:717-393-8540
Practice Address - Street 1:2445 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1942
Practice Address - Country:US
Practice Address - Phone:717-393-1365
Practice Address - Fax:717-393-8540
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036013E174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7014809OtherGEISINGER
0099126000OtherAMERIHEALTH HMO
PA0421114OtherHIGHMARK BLUE SHIELD
PA117425OtherUNISON
PA0011635840001OtherACCESS
PA1326036468OtherNPI
030003465OtherRAILROAD MEDICARE
0412114OtherKEYSTONE HEALTH PLAN CENT
117425OtherTHREE RIVERS (MEDPLUS)
0099126000OtherKEYSTONE HEALTH PLAN EAST
1519641OtherGATEWAY
248732OtherMAMSI
30108AOtherAMERIHEALTH MERCY
PA001163584Medicaid
01799101OtherCAPITAL BLUE CROSS
0421114OtherBC/BS PERSONAL CHOICE
PA421114GLFOtherMEDICARE, PIN UNSPECIFIED
0466380OtherAETNA
7125391002OtherCIGNA
PA117425OtherUNISON