Healthcare Provider Details

I. General information

NPI: 1083165401
Provider Name (Legal Business Name): EMILY C. GENOVESE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY C. HALLAMEYER PA-C

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST. PAUL PLACE LOWER LEVEL
BALTIMORE MD
21202
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-539-3434
  • Fax:
Mailing address:
  • Phone: 410-539-2227
  • Fax: 410-539-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC06221
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: