Provider Demographics
NPI:1346295359
Name:ALLENTOWN INFECTIOUS DISEASES SERVICES, INC.
Entity Type:Organization
Organization Name:ALLENTOWN INFECTIOUS DISEASES SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:KNOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:610-402-8430
Mailing Address - Street 1:1210 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6229
Mailing Address - Country:US
Mailing Address - Phone:610-402-8430
Mailing Address - Fax:610-402-1676
Practice Address - Street 1:1210 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 2700
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6229
Practice Address - Country:US
Practice Address - Phone:610-402-8430
Practice Address - Fax:610-402-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010336500003Medicaid
PA0041202000OtherKHPE
PA02348100OtherCBC, KHPC
PA0010336500003Medicaid