1912900952 NPI number — STEPHEN C KAUFFMAN M.D.

Table of content: STEPHEN C KAUFFMAN M.D. (NPI 1912900952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912900952 NPI number — STEPHEN C KAUFFMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFFMAN
Provider First Name:
STEPHEN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1912900952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 N BEAUREGARD ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22302-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-820-7000
Provider Business Mailing Address Fax Number:
703-931-0059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 N BEAUREGARD ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22302-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-820-7000
Provider Business Practice Location Address Fax Number:
703-931-0059
Provider Enumeration Date:
05/23/2005

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: 208D00000X , with the licence number:  0101017616 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 035936 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2156 . This is a "CARE FIRST B/C B/S GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0003 . This is a "B/C B/S INIDVIDUAL #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 246821 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7471203 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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