Basic Information
| Provider Information | |||||||||
| NPI: | 1912965914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAUTILLI | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| 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 120 | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673649100 | ||||||||
| FaxNumber: | 2673649100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD036719E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0432873000 | 01 | KEYSTONE HEALTHPLAN EAST | OTHER | 610024 | 01 | BLUE CHOICE | OTHER | 0012739980003 | 05 | PA | MEDICAID | 0012739980002 | 05 | PA | MEDICAID | 200045805 | 01 | RAILROAD MEDICARE | OTHER | 0012739980001 | 05 | PA | MEDICAID | 610024 | 01 | PERSONAL CHOICE | OTHER | 2981923 | 01 | AETNA | OTHER | 5007871006 | 01 | CIGNA | OTHER | 610024 | 01 | PA | BLUE SHIELD | OTHER |