Organization
GENESIS ELDER CARE PHYSICIAN SERVICES LLC
Active
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
Update your record
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