Provider Demographics
NPI:1255345237
Name:KAUFMANN, AGNES (PA)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:FURGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 BICENTENNIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1962
Mailing Address - Country:US
Mailing Address - Phone:413-733-4101
Mailing Address - Fax:413-789-8048
Practice Address - Street 1:305 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1962
Practice Address - Country:US
Practice Address - Phone:413-733-4101
Practice Address - Fax:413-789-8048
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ22881Medicare UPIN
MAAP1806Medicare ID - Type Unspecified