Provider Demographics
NPI:1457385577
Name:KAUFMAN, MONTE I (MD)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:I
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:781-756-8989
Mailing Address - Fax:781-756-1919
Practice Address - Street 1:611 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-756-8989
Practice Address - Fax:781-756-1919
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA450202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0105309Medicaid
MAE05206Medicare ID - Type Unspecified
MA0105309Medicaid