Organization
KANOUSE MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY DOUGLAS KANOUSE MD (PHYSICIAN)
(570) 752-5500
Entity
Organization
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
MD-036479-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1335094
HIGHMARK BLUE SHIELD
PA
01
—
50002681
CAPITAL BLUE CROSS
PA
Enumeration date
11/20/2006
Last updated
08/22/2020
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