MEDICARE: ALLENTOWN INFECTIOUS DISEASES SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0041202000	OTHER	PA	KHPE
3	02348100	OTHER	PA	CBC, KHPC

General Provider Information

NPI Number	:	1346295359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLENTOWN INFECTIOUS DISEASES SERVICES, INC.

Provider Business Mailing Address
First Line	:	1210 S CEDAR CREST BLVD
Second Line	:	SUITE 2700
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6229
Country	:	US
Telephone Number	:	610-402-8430
Fax Number	:	610-402-1676

Provider Business Practice Location Address
First Line	:	1210 S CEDAR CREST BLVD
Second Line	:	SUITE 2700
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6229
Country	:	US
Telephone Number	:	610-402-8430
Fax Number	:	610-402-1676

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK C KNOUSE
Credential	:	M.D., F.A.C.P.
Telephone Number	:	610-402-8430

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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