Healthcare Provider Details

I. General information

NPI: 1417732116
Provider Name (Legal Business Name): GENESIS MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 ENCLAVE DR
NEW CASTLE PA
16105-3208
US

IV. Provider business mailing address

8150 PERRY HWY STE 201
PITTSBURGH PA
15237-5200
US

V. Phone/Fax

Practice location:
  • Phone: 724-657-3201
  • Fax: 724-657-3223
Mailing address:
  • Phone: 412-369-9550
  • Fax: 412-369-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD STEVENSON
Title or Position: CFO
Credential:
Phone: 412-369-9550