Organization
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SHAPIRO (VP, CONTROLLER)
(410) 832-7790
Entity
Organization
Contact information
Practice address
464 MAIN ST, HERITAGE HALL EAST, AGAWAM, MA 01001
(413) 786-8000
(413) 789-1099
Mailing address
PO BOX 62946, BALTIMORE, MD 21264-2946
(410) 494-7607
(610) 925-7387
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
75866
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9770917
—
MA
Enumeration date
08/24/2005
Last updated
08/05/2019
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