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General NPI Number Information
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NPI Number | 1447510714
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Entity Type | Organization
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Legal Business Name | GENESIS ELDER CARE PHYSICIAN SERVICES LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 200 CIVIC AVE
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City | SALISBURY
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State | MD
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Zip | 21804-4599
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Country | US
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Telephone | 410-749-1466
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42738
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City | TOWSON
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State | MD
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Zip | 21284-2738
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Country | US
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Telephone | 410-494-7607
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Fax | 610-925-7387
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Authorized Official
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Title or Position | VP, AREA CONTROLLER
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Name | ERIC SHAPIRO
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Credential |
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Telephone | 410-832-7790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | R188822
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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