Basic Information
Provider Information
NPI: 1104269190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KILCOYNE
FirstName: JAMES
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 41 UNIVERSITY DR STE 300
Address2:  
City: NEWTOWN
State: PA
PostalCode: 189401873
CountryCode: US
TelephoneNumber: 2157105522
FaxNumber: 2157105181
Practice Location
Address1: 1203 LANGHORNE NEWTOWN RD STE 400
Address2:  
City: LANGHORNE
State: PA
PostalCode: 190471209
CountryCode: US
TelephoneNumber: 2157577212
FaxNumber: 2157577274
Other Information
ProviderEnumerationDate: 04/10/2013
LastUpdateDate: 05/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XOS019779PAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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