Organization
MERCY MANAGEMENT OF SEPA
Active
Other names
MMS-Richard Kanoff, DO
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C SMITH (VP FINANCIAL SERVICES)
(610) 567-6964
Entity
Organization
Contact information
Practice address
1501 LANSDOWNE AVE, SUITE 308 MOB, DARBY, PA 19023-1333
(610) 534-6142
(610) 537-6136
Mailing address
1 W ELM ST, 2ND FLOOR, CONSHOHOCKEN, PA 19428-2007
(610) 567-6964
(610) 567-6170
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007787930153
—
PA
01
—
1251849000
OWCP
PA
01
—
1544398
BLUE SHIELD
PA
01
—
2229023000
KEYSTONE HEALTH PLAN EAST
PA
01
—
2610873
AETNA HMO
PA
01
—
30010754
KEYSTONE MERCY HEALTH PLA
PA
01
—
4595900
AETNA PPO
PA
01
—
DA5351
RAILROAD MEDICARE
PA
Enumeration date
12/20/2005
Last updated
01/11/2008
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