Provider Demographics
NPI:1265510572
Name:KAUFMAN, DIANE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
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 1:18650 NW CORNELL RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9207
Mailing Address - Country:US
Mailing Address - Phone:503-352-0468
Mailing Address - Fax:503-352-1024
Practice Address - Street 1:18650 NW CORNELL RD
Practice Address - Street 2:SUITE 315
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9207
Practice Address - Country:US
Practice Address - Phone:503-352-0468
Practice Address - Fax:503-352-1024
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1689452084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C11362Medicare UPIN