Provider Demographics
NPI:1619996063
Name:KAUFMAN, BRIAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2401
Mailing Address - Country:US
Mailing Address - Phone:207-942-6226
Mailing Address - Fax:207-992-2756
Practice Address - Street 1:1365 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2401
Practice Address - Country:US
Practice Address - Phone:207-942-6226
Practice Address - Fax:207-992-2756
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18970208VP0000X, 204D00000X, 2083A0300X
ME1984208VP0014X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3107372Medicaid
ME4325691900Medicaid
ME0000187Medicare PIN