Provider Demographics
NPI:1093920266
Name:KAUFMAN, ELLIOT MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:MARTIN
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 1:714 BEAR ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03576-5513
Mailing Address - Country:US
Mailing Address - Phone:603-237-8994
Mailing Address - Fax:603-237-8994
Practice Address - Street 1:154 DUCHESS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5516
Practice Address - Country:US
Practice Address - Phone:802-334-6744
Practice Address - Fax:802-334-7450
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0166832084P0800X
VT042-00114142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001362Medicaid