Provider Demographics
NPI:1821056813
Name:CAUTILLI ORTHOPAEDIC SURGICAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:CAUTILLI ORTHOPAEDIC SURGICAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-504-6101
Mailing Address - Street 1:115 FLORAL VALE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5522
Mailing Address - Country:US
Mailing Address - Phone:215-504-6101
Mailing Address - Fax:215-504-1910
Practice Address - Street 1:115 FLORAL VALE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5522
Practice Address - Country:US
Practice Address - Phone:215-504-6101
Practice Address - Fax:215-504-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019413930001Medicaid
2981909OtherAETNA
1421680OtherPERSONAL CHOICE NUMBERS
1421680OtherBLUE CHOICE
PA0019413930002Medicaid
2110238000OtherKEYSTONE HEALTHPLAN EAST
CA1421680OtherPA BLUE SHIELD GROUP
2110238000OtherKEYSTONE HEALTHPLAN EAST