# GENESIS ELDERCARE PHYSICIAN SERVICES I LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790920288
- **Authorized official:** CATHERINE TREGOE (DIRECTOR OF BUSINESS OPERATIONS)
- **Authorized official phone:** (410) 543-8870

## Contact information

- **Practice address:** 9 HAYWOOD AVE, RUTLAND, VT 05701-4832
- **Practice address phone:** (410) 543-1957
- **Mailing address:** 801 N SALISBURY BLVD, SUITE 201, SALISBURY, MD 21801-3624
- **Mailing address phone:** (410) 543-1957

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 12/11/2008
- **Last updated:** 12/12/2008