Provider Demographics
NPI:1760485197
Name:KANE, JOHN T (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:KANE
Suffix:
Gender:M
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:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005624L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011142670002Medicaid
PA0022528000OtherKEYSTONE IBC
PA095849OtherHIGHMARK BLUE SHIELD
PA19711OtherAETNA HMO
PA095849OtherHIGHMARK BLUE SHIELD
PA0011142670002Medicaid