Provider Demographics
NPI:1245348150
Name:KANOFF, STEVEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:KANOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:840 WALNUT STREET
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-440-3160
Mailing Address - Fax:215-928-3465
Practice Address - Street 1:840 WALNUT STREET
Practice Address - Street 2:SUITE 1230
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3041
Practice Address - Fax:215-928-3225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043714E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011674850003Medicaid
PA178774Medicare ID - Type Unspecified
PA203423Medicare PIN
PA0011674850003Medicaid