MEDICARE: ROBERT W KAVILLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD037576E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770542789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT W KAVILLE MD

Provider Business Mailing Address
First Line	:	101 BERRY HILL RD
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-7611
Country	:	US
Telephone Number	:	570-348-2280
Fax Number	:	570-348-0647

Provider Business Practice Location Address
First Line	:	101 BERRY HILL RD
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-7611
Country	:	US
Telephone Number	:	570-348-2280
Fax Number	:	570-348-0647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	05/18/2020

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