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General NPI Number Information
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NPI Number | 1477045284
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Entity Type | Individual
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Provider Name | MATTHEW RYAN KNOUSE MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 S BANCROFT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-4720
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Country | US
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Telephone | 172-754-3697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | T8248
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | TPME5446
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT215706
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD479088
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License Number State | PA
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