Provider Demographics
NPI:1023059987
Name:KAUFMANN, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KAUFMANN
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:PO BOX 3379
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3379
Mailing Address - Country:US
Mailing Address - Phone:877-242-3459
Mailing Address - Fax:
Practice Address - Street 1:336 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5008
Practice Address - Country:US
Practice Address - Phone:828-263-1211
Practice Address - Fax:828-262-4103
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197282208M00000X
NC85538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023059987Medicaid
NY01521677Medicaid
NY35126CMedicare PIN
NYP110088510Medicare PIN