Healthcare Provider Details

I. General information

NPI: 1205291333
Provider Name (Legal Business Name): LIAM THOMAS KANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HUNTINGDON PIKE STE 100
ROCKLEDGE PA
19046-4312
US

IV. Provider business mailing address

120 HUNTINGDON PIKE STE 100
ROCKLEDGE PA
19046-4312
US

V. Phone/Fax

Practice location:
  • Phone: 215-663-5610
  • Fax: 833-941-3871
Mailing address:
  • Phone: 215-663-5610
  • Fax: 833-941-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD491213
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number30054243
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: