=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023076965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE PETER CAUTILLI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 05/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1203 LANGHORNE NEWTOWN RD STE 120
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-364-9100
-----------------------------------------------------
Fax | 267-364-9101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 UNIVERSITY DR STE 300
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-710-5522
-----------------------------------------------------
Fax | 157-105-1812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD039658E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------