Healthcare Provider Details

I. General information

NPI: 1043730344
Provider Name (Legal Business Name): ROYAL D MCKENNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 N OXFORD VALLEY RD FL 1
LANGHORNE PA
19047-8304
US

IV. Provider business mailing address

380 N OXFORD VALLEY RD FL 1
LANGHORNE PA
19047-8304
US

V. Phone/Fax

Practice location:
  • Phone: 215-409-9300
  • Fax: 215-409-9301
Mailing address:
  • Phone: 215-409-9300
  • Fax: 215-409-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036153421
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD495229
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036153421
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: