Provider Demographics
NPI:1982047072
Name:KAUFFMAN, KATHRYN LAURA (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LAURA
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LAURA
Other - Last Name:HOLYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:5501 OLD YORK RD FL LIFTER2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6828
Practice Address - Fax:215-456-6769
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0005282208000000X
PAOS0183592080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033863200004Medicaid