MEDICARE: DR. CHARLES PATRICK GENNAULA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD050096L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013914746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES PATRICK GENNAULA M.D.

Provider Business Mailing Address
First Line	:	315 STETTLER DR
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3164
Country	:	US
Telephone Number	:	412-287-0699
Fax Number	:	724-929-3229

Provider Business Practice Location Address
First Line	:	100 PEASANT VILLAGE LN
Second Line	:	SUITE 100
City	:	BELLE VERNON
State	:	PA
Zip	:	15012-4333
Country	:	US
Telephone Number	:	724-929-7800
Fax Number	:	724-929-3229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/08/2017

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