Basic Information
| Provider Information | |||||||||
| NPI: | 1942251491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENUIT | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W BELVEDERE AVE | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015524 | ||||||||
| FaxNumber: | 4106018946 | ||||||||
| Practice Location | |||||||||
| Address1: | 2435 W BELVEDERE AVE | ||||||||
| Address2: | SUITE 42 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106010600 | ||||||||
| FaxNumber: | 4106015835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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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 | 208600000X | D55119 | MD | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | D55119 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | D55119 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00089285 | 01 | MD | R/R MEDICARE PROVIDER # | OTHER | C31152 | 01 | MD | R/R MEDICARE GROUP # | OTHER |