MEDICARE: KANOUSE MEDICAL GROUP PC

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	207R00000X	Internal Medicine Physician	MD-036479-E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50002681	OTHER	PA	CAPITAL BLUE CROSS
2	1335094	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1790859783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANOUSE MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	695 E 16TH ST
Second Line	:	SUITE D
City	:	BERWICK
State	:	PA
Zip	:	18603-2320
Country	:	US
Telephone Number	:	570-752-5500
Fax Number	:	570-752-6790

Provider Business Practice Location Address
First Line	:	695 E 16TH ST
Second Line	:	SUITE D
City	:	BERWICK
State	:	PA
Zip	:	18603-2320
Country	:	US
Telephone Number	:	570-752-5500
Fax Number	:	570-752-6790

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. GARY DOUGLAS KANOUSE
Credential	:	MD
Telephone Number	:	570-752-5500

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1295733418 — ROGER F CRAKE MD
Practice Location Address:

695 E 16TH ST , SUITE C
BERWICK, PA
18603-2320

Practice Phone: 570-759-3561
Practice Fax: 570-759-0314

1255316030 — KATHY EILEEN BAYLOR MD
Practice Location Address:

695 E 16TH ST STE B
BERWICK, PA
18603-2320

Practice Phone: 570-759-2203
Practice Fax: 570-759-2253

1194780643 — DR. ZEFERINO MARTINEZ M.D.
Practice Location Address:

695 E 16TH ST , SUITE F
BERWICK, PA
18603-2320

Practice Phone: 570-759-5111
Practice Fax: 570-802-5778

1760440853 — DR. RAMESH M. SHAH M.D.
Practice Location Address:

695 E 16TH ST , SUITE A
BERWICK, PA
18603-2320

Practice Phone: 570-759-5005
Practice Fax:

1568521425 — DR. GARY DOUGLAS KANOUSE M.D.
Practice Location Address:

695 E 16TH ST , SUITE D
BERWICK, PA
18603-2320

Practice Phone: 570-752-5500
Practice Fax: 570-752-6790

1033269378 — VALLEY SPINE SPECIALISTS, PC
Practice Location Address:

695 E 16TH ST , SUITE F
BERWICK, PA
18603-2320

Practice Phone: 570-802-0360
Practice Fax: 570-802-0363

Directions to “KANOUSE MEDICAL GROUP PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.