Individual
DR. GARY DOUGLAS KANOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
695 E 16TH ST, SUITE D, BERWICK, PA 18603-2320
(570) 752-5500
(570) 752-6790
Mailing address
695 E 16TH ST, SUITE D, BERWICK, PA 18603-2320
(570) 752-5500
(570) 752-6790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD036479E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011256360001
—
PA
01
—
161376
HIGHMARK BLUE SHIELD
PA
01
—
50002681
CAPITAL BLUE CROSS
PA
Enumeration date
12/07/2006
Last updated
07/08/2007
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