Provider Demographics
NPI:1891761946
Name:KAUFMAN, R LISA (NP)
Entity Type:Individual
Prefix:
First Name:R LISA
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-595-2505
Practice Address - Fax:508-854-0650
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0391310Medicaid
042472266OtherTHREE RIVERS
042472266008OtherTRICARE CHAMPUS
NP3652OtherBLUE SHIELD HMO BLUE
NP3652OtherBLUE SHIELD INDEMNITY
NP3652OtherBLUE CARE ELECT
AA635OtherHARVARD PILGRIM HEALTHCAR
0391310OtherMEDICAID WELFARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
61996OtherFALLON COMMUNITY HEALTH P
MANP3652Medicare ID - Type Unspecified
0391310OtherMEDICAID WELFARE
042472266OtherPRIVATE HEALTHCARE SYSTEM