Provider Demographics
NPI:1235426024
Name:KANOUSE, ZACHARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:A
Last Name:KANOUSE
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 1:214 CORNELIA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2332
Mailing Address - Country:US
Mailing Address - Phone:518-561-6410
Mailing Address - Fax:
Practice Address - Street 1:214 CORNELIA ST STE 102
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2332
Practice Address - Country:US
Practice Address - Phone:518-561-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290259208600000X
VT042.0013514208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery