Provider Demographics
NPI:1912965914
Name:CAUTILLI, RICHARD ANTHONY JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANTHONY
Last Name:CAUTILLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD STE 120
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1211
Practice Address - Country:US
Practice Address - Phone:267-364-9100
Practice Address - Fax:267-364-9100
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036719E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0432873000OtherKEYSTONE HEALTHPLAN EAST
610024OtherBLUE CHOICE
PA0012739980003Medicaid
PA0012739980002Medicaid
200045805OtherRAILROAD MEDICARE
PA0012739980001Medicaid
610024OtherPERSONAL CHOICE
2981923OtherAETNA
5007871006OtherCIGNA
PA610024OtherBLUE SHIELD
PA0012739980001Medicaid