Healthcare Provider Details

I. General information

NPI: 1013914746
Provider Name (Legal Business Name): CHARLES PATRICK GENNAULA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEASANT VILLAGE LN SUITE 100
BELLE VERNON PA
15012-4333
US

IV. Provider business mailing address

315 STETTLER DR
JEFFERSON HILLS PA
15025-3164
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-7800
  • Fax: 724-929-3229
Mailing address:
  • Phone: 412-287-0699
  • Fax: 724-929-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD050096L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: