Provider Demographics
NPI:1952425068
Name:KAUFFMAN, CHRISTIAN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:KAUFFMAN
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:MC 21-70
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6363
Practice Address - Fax:570-214-9208
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL1474390200000X
PAMD443338208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2010-00677OtherLICENSE
NVLL1474OtherMEDICAL LICENSE
PAMD443338OtherMEDICAL LICENSE
PAMD443338OtherMEDICAL LICENSE
NVASO2532198958OtherDEA CERTIFICATE