Provider Demographics
NPI:1184680076
Name:KAUFMAN, KRISTIE L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:L
Other - Last Name:SCHUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3901 S ATHERTON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8324
Mailing Address - Country:US
Mailing Address - Phone:814-466-7921
Mailing Address - Fax:814-466-6570
Practice Address - Street 1:3901 S ATHERTON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-7921
Practice Address - Fax:814-466-6570
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071459L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics