Provider Demographics
NPI:1992788012
Name:SUSAN M KAUFMAN DO
Entity type:Organization
Organization Name:SUSAN M KAUFMAN DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-664-3979
Mailing Address - Street 1:300 YORK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1420
Mailing Address - Country:US
Mailing Address - Phone:814-664-3979
Mailing Address - Fax:814-663-4879
Practice Address - Street 1:300 YORK ST
Practice Address - Street 2:SUITE B
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1420
Practice Address - Country:US
Practice Address - Phone:814-664-3979
Practice Address - Fax:814-663-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006866L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1053316489OtherNPI NUMBER
PA580453TEWMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA1053316489OtherNPI NUMBER
PA002000TEWMedicare ID - Type UnspecifiedCRNP PROVIDER NUMBER
PAE27621Medicare UPIN