Provider Demographics
NPI:1124021431
Name:KANE, JILL R (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:KANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-943-1200
Mailing Address - Fax:215-943-6650
Practice Address - Street 1:2 QUINCY DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1924
Practice Address - Country:US
Practice Address - Phone:215-943-1200
Practice Address - Fax:215-943-6650
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008875L207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016972110005Medicaid
PA0675842000OtherKEYSTONE IBC
PA975165OtherHIGHMARK BLUE SHIELD
PA6560301OtherAETNA HMO
PA0675842000OtherKEYSTONE IBC
PA0016972110005Medicaid