Provider Demographics
NPI:1518965748
Name:BUFALINO, KEVIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:BUFALINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0504
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071193002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0767272000OtherAMERIHEALTH HMO
1121373OtherHORIZON NJ HEALTH
627408OtherAMERIHEALTH PPO
10652593OtherCAQH
2109649OtherUNITED HEALTHCARE
2379667OtherAETNA
NJ8326002Medicaid
300114030OtherRAILROAD MEDICARE
627408OtherHIGHMARK PA BLUE SHIELD
A3738029OtherOXFORD HEALTH
627408OtherPREMIER BLUE
10652593OtherCAQH
627408OtherAMERIHEALTH PPO