1326036468 NPI number — DR. CLARK ROBERT KAUFMAN MD

Table of content: HEIDI HAYHOE (NPI 1518362540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326036468 NPI number — DR. CLARK ROBERT KAUFMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
CLARK
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326036468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2445 MARIETTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17601-1942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-393-1365
Provider Business Mailing Address Fax Number:
717-393-8540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2445 MARIETTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-393-1365
Provider Business Practice Location Address Fax Number:
717-393-8540
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD036013E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207K00000X , with the licence number: MD036013E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7014809 . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0099126000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0421114 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 117425 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011635840001 . This is a "ACCESS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1326036468 . This is a "NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 030003465 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0412114 . This is a "KEYSTONE HEALTH PLAN CENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 117425 . This is a "THREE RIVERS (MEDPLUS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0099126000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1519641 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 248732 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30108A . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001163584 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01799101 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0421114 . This is a "BC/BS PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421114GLF . This is a "MEDICARE, PIN UNSPECIFIED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0466380 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7125391002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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