Provider Demographics
NPI:1538374038
Name:JOHN P KAUFMAN MD PC
Entity type:Organization
Organization Name:JOHN P KAUFMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PEARSE
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-981-9367
Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:#204
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2465
Mailing Address - Country:US
Mailing Address - Phone:540-981-9367
Mailing Address - Fax:540-981-0031
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:#204
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-981-9367
Practice Address - Fax:540-981-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020590207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0004421681OtherAETNA
VA061468OtherANTHEM BLUE CROSS BLUE SH
VAC08708Medicare PIN
DG2723Medicare PIN