Provider Demographics
NPI:1568464832
Name:KAUFMAN, STEPHEN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
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 1:4676 DOUGLAS CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3619
Mailing Address - Country:US
Mailing Address - Phone:330-494-1116
Mailing Address - Fax:330-494-0276
Practice Address - Street 1:4676 DOUGLAS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3619
Practice Address - Country:US
Practice Address - Phone:330-494-1116
Practice Address - Fax:330-494-0276
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061194207WX0107X
PAMD66059L207W00000X
OH35061194207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0851618Medicaid
PA0017080100001Medicaid
OH0699444Medicare PIN
OH0699448Medicare PIN
OH0699445Medicare PIN
PA018605LXDMedicare PIN
OHF01533Medicare UPIN
PAP00024784Medicare PIN
OH0851618Medicaid
OH180033517Medicare PIN