Healthcare Provider Details

I. General information

NPI: 1619936044
Provider Name (Legal Business Name): KATHLEEN JENNIFER KNOUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 RED HILL CT
NEWPORT PA
17074-8706
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 717-567-3151
  • Fax: 717-567-7571
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD044031L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: