Provider Demographics
NPI:1841457876
Name:KAUFFMAN, LARA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:MICHELLE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:MICHELLE
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 FRY RD
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-9610
Mailing Address - Country:US
Mailing Address - Phone:717-576-8997
Mailing Address - Fax:
Practice Address - Street 1:6596 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-7804
Practice Address - Country:US
Practice Address - Phone:717-749-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431945207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102171304Medicaid