Provider Demographics
NPI:1336120922
Name:KANOFF, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KANOFF
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 1:1 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:SUITE 308 MOB
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:610-534-6142
Practice Address - Fax:610-534-6130
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003560207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008884240004Medicaid
PA148829OtherBLUE SHIELD
PA322006OtherKMHP
PA4595900OtherAETNA PPO
PA0052240000OtherKEYSTONE HEALTH PLAN EAST
PA2610873OtherAETNA HMO
PA0100215OtherCIGNA
PA322006OtherKMHP
PA0052240000OtherKEYSTONE HEALTH PLAN EAST