Provider Demographics
NPI:1689687097
Name:KAUFMAN, DIANE B (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:B
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 KATO DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2446
Mailing Address - Country:US
Mailing Address - Phone:617-754-0440
Mailing Address - Fax:617-754-0446
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:617-754-0440
Practice Address - Fax:617-754-0446
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9780378Medicaid
MAF72938Medicare UPIN