MEDICARE: ROSEMARIA GENNUSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	M0411	TX
2	208000000X	Pediatrics Physician	M0411	TX
3	2086S0102X	Surgical Critical Care Physician	M0411	TX
4	2086X0206X	Surgical Oncology Physician	M0411	TX
5	2086S0120X	Pediatric Surgery Physician	M0411	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8BX390	OTHER		BCBS TX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	178202106	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1093771297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIA GENNUSO MD

Provider Business Mailing Address
First Line	:	8109 FREDERICKSBURG RD
Second Line	:	PHYSICIAN PRACTICE SERVICES
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3311
Country	:	US
Telephone Number	:	210-575-6240
Fax Number	:	210-575-6280

Provider Business Practice Location Address
First Line	:	4410 MEDICAL DR
Second Line	:	STE 540
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6306
Country	:	US
Telephone Number	:	210-575-6240
Fax Number	:	210-575-6280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	01/27/2022

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Directions to “ ROSEMARIA GENNUSO MD” Practice Location

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