Provider Demographics
NPI:1851474886
Name:MCCANS, KATHRYN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MCCANS
Suffix:
Gender:F
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:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-4587
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469591207P00000X
PAMD050507L2080P0204X, 207PP0204X
NJMA641772080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0707002000OtherAMERIHEALTH/KEYSTONE/IBC
NJ2118050OtherUNITED HEALTHCARE
NJ3500503OtherAETNA
NJP3549980OtherOXFORD
NJ6737244OtherCIGNA
NJ763187OtherAMERIHEALTH PPO/PA BS
NJ18994OtherUNIVERSITY HEALTH PLAN
NJ60005649OtherHORIZON NJ HEALTH
NJ010006264 00OtherAMERICHOICE
NJ7046600Medicaid
NJP3549980OtherOXFORD
F77243Medicare UPIN