Healthcare Provider Details

I. General information

NPI: 1477603314
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: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 PERRY HWY
PITTSBURGH PA
15237-2160
US

IV. Provider business mailing address

8150 PERRY HWY STE 200
PITTSBURGH PA
15237-5232
US

V. Phone/Fax

Practice location:
  • Phone: 412-364-4402
  • Fax: 412-364-4402
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