Basic Information
| Provider Information | |||||||||
| NPI: | 1851307094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 E HOLLIS ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030602928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774000 | ||||||||
| FaxNumber: | 6035773497 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 E HOLLIS ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030602928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774000 | ||||||||
| FaxNumber: | 6035773497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 7951 | NH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | 12774 | ME | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30202035 | 05 | NH | MEDICAID |