Provider Demographics
NPI:1811952260
Name:RADBILL, MARK KENNY (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:KENNY
Last Name:RADBILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2426 BRISTOL RD
Mailing Address - Street 2:NESHAMINY VALLEY COMMONS
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-757-1533
Mailing Address - Fax:215-752-2402
Practice Address - Street 1:2426 BRISTOL RD
Practice Address - Street 2:NESHAMINY VALLEY COMMONS
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-757-1533
Practice Address - Fax:215-752-2402
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002663L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA05002663LMedicaid
PA028810OtherAOA
PA05002663LMedicaid
PA099407Medicare PIN