Provider Demographics
NPI:1659357762
Name:MERCY MANAGEMENT OF SEPA
Entity Type:Organization
Organization Name:MERCY MANAGEMENT OF SEPA
Other - Org Name:MMS-RICHARD KANOFF, DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6964
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:2ND FLOOR
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 1:1501 LANSDOWNE AVE
Practice Address - Street 2:SUITE 308 MOB
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6142
Practice Address - Fax:610-537-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1251849000OtherOWCP
PA1544398OtherBLUE SHIELD
PA4595900OtherAETNA PPO
PA2610873OtherAETNA HMO
PA30010754OtherKEYSTONE MERCY HEALTH PLA
PADA5351OtherRAILROAD MEDICARE
PA2229023000OtherKEYSTONE HEALTH PLAN EAST
PA1007787930153Medicaid
PA4595900OtherAETNA PPO