MEDICARE: DORSAM & GENERIE, OD, LLC

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	152WC0802X	Corneal and Contact Management Optometrist	TA1997	MD

General Provider Information

NPI Number	:	1306272869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORSAM & GENERIE, OD, LLC

Provider Business Mailing Address
First Line	:	5725 RICHARDS VALLEY RD STE A9
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6964
Country	:	US
Telephone Number	:	443-420-8113
Fax Number	:	443-420-8113

Provider Business Practice Location Address
First Line	:	6230 OLD DOBBIN LN STE 190
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5954
Country	:	US
Telephone Number	:	443-420-8113
Fax Number	:	443-973-6998

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. CHRISTINA GENERIE
Credential	:	O.D.
Telephone Number	:	443-420-8113

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	04/07/2025

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