Organization
GENESIS ELDER CARE 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
161 BAKERS RIDGE RD, MORGANTOWN, WV 26508-1459
(304) 285-0692
Mailing address
PO BOX 42738, TOWSON, MD 21284-2738
(410) 494-7607
(610) 925-7387
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001777
—
WV
Enumeration date
07/19/2006
Last updated
04/13/2018
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