Basic Information
| Provider Information | |||||||||
| NPI: | 1326283045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS ELDER CARE PHYSICIAN SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42738 | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212842738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104947607 | ||||||||
| FaxNumber: | 6109257387 | ||||||||
| Practice Location | |||||||||
| Address1: | 6508 DEER POINTE DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218041668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105431957 | ||||||||
| FaxNumber: | 4105438492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2008 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | SHAPIRO | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, AREA CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4108327790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207QA0505X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207RG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.