Provider Demographics
NPI:1467487595
Name:KYRILLOS, JANINE V (MD)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:V
Last Name:KYRILLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 E CITY AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1704
Mailing Address - Country:US
Mailing Address - Phone:610-664-0134
Mailing Address - Fax:610-664-2945
Practice Address - Street 1:225 E CITY AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1704
Practice Address - Country:US
Practice Address - Phone:610-664-0134
Practice Address - Fax:610-664-2945
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-418857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001906296Medicaid
NJ8898201Medicaid
PA001906296Medicaid