Basic Information
| Provider Information | |||||||||
| NPI: | 1891756748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENVERT | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1342 SOUTH DIVISION STREET | ||||||||
| Address2: | UNIT 401 | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105462133 | ||||||||
| FaxNumber: | 4105483361 | ||||||||
| Practice Location | |||||||||
| Address1: | 1342 SOUTH DIVISION STREET | ||||||||
| Address2: | UNIT 401 | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105462133 | ||||||||
| FaxNumber: | 4105483361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | D34976 | MD | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 444681000 | 05 | MD | MEDICAID |