Provider Demographics
NPI:1154328961
Name:KANN, DAVID GORDON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GORDON
Last Name:KANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:338 ALEXANDER SPRING RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9129
Practice Address - Country:US
Practice Address - Phone:717-218-5103
Practice Address - Fax:717-303-3729
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034384E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01893702OtherCAPITAL BLUE CROSS
PA060068464OtherRAILROAD MEDICARE
PA2804534OtherAETNA
PA1521307OtherGATEWAY
PA524509OtherHIGHMARK BLUE SHIELD
PA011410770007Medicaid
PA1521307OtherGATEWAY
PA01893702OtherCAPITAL BLUE CROSS