MEDICARE: TIMOTHY KEARNEY PA-C

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	363AM0700X	Medical Physician Assistant	MA-002777-L	PA
2	363A00000X	Physician Assistant	OA004633	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970007653	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019752	OTHER	PA	BLUE CARE

General Provider Information

NPI Number	:	1518952506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY KEARNEY PA-C

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	1020 NORTHERN BLVD
Second Line	:
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-2220
Country	:	US
Telephone Number	:	570-587-2290
Fax Number	:	570-587-1874

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/13/2025

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Directions to “ TIMOTHY KEARNEY PA-C” Practice Location

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