Healthcare Provider Details

I. General information

NPI: 1417277146
Provider Name (Legal Business Name): EMILIA GENOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST DEPT OF SURGERY
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

2660 MAIN ST SUITE 110
BRIDGEPORT CT
06606-5369
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-5436
  • Fax:
Mailing address:
  • Phone: 203-576-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number53884
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: