Provider Demographics
NPI:1487787131
Name:KANOUFF, ALAN JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:JOSEPH
Last Name:KANOUFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4722
Mailing Address - Country:US
Mailing Address - Phone:814-946-2845
Mailing Address - Fax:814-946-1274
Practice Address - Street 1:800 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4722
Practice Address - Country:US
Practice Address - Phone:814-946-2845
Practice Address - Fax:814-946-1274
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013067207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020766280001Medicaid
PA1020766280001Medicaid