Provider Demographics
NPI:1205991890
Name:KAUFMAN, CRAIG M (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:M
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2650
Mailing Address - Country:US
Mailing Address - Phone:860-666-2078
Mailing Address - Fax:860-665-8247
Practice Address - Street 1:505 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2650
Practice Address - Country:US
Practice Address - Phone:860-666-2078
Practice Address - Fax:860-665-8247
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00741213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480000854Medicare ID - Type Unspecified