Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kevin Ly

Individual provider Family Medicine Physician · NPI 1720564289

Kevin Ly is a Family Practice in Bloomsburg, Pennsylvania. Qualified in 2018, 8 years ago. Practices with Geisinger Clinic, a 3,413-clinician group and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
8
Licensed in
PA
In the registry since
2018

Practice location Address checks out

240 Mall Blvd
Bloomsburg, PA 17815-8306
Phone: (570) 784-8303
Fax: (570) 387-5030
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence MD475200 (PA)

Record details

NPI number1720564289
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 17, 2018
Last updated in NPPESSeptember 11, 2025
Certification dateSeptember 11, 2025
Mailing address100 N Academy Ave, Danville, PA 17822-4903

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Geisinger Clinic — 3413 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Bloomsburg