Healthcare Provider Details

I. General information

NPI: 1053461996
Provider Name (Legal Business Name): GENESIS MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 CORPORATE DR STE 700
PITTSBURGH PA
15237-5829
US

IV. Provider business mailing address

8150 PERRY HWY STE 201
PITTSBURGH PA
15237-5200
US

V. Phone/Fax

Practice location:
  • Phone: 412-630-2670
  • Fax: 412-630-2613
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