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NPI Code Detail

MEDICARE: DR. JASON ALAN GENIN D.O.

MEDICARE: DR. JASON ALAN GENIN D.O.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207QS0010XSports Medicine (Family Medicine) Physician34.009572OH

General Provider Information

NPI Number : 1548466493
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON ALAN GENIN D.O.
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 440-204-7800
Fax Number : 440-204-7815
Provider Business Practice Location Address
First Line : 5800 COOPER FOSTER PARK RD W
Second Line :
City : LORAIN
State : OH
Zip : 44053-4131
Country : US
Telephone Number : 440-204-7800
Fax Number : 440-204-7815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 10/19/2011

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