Organization
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SHAPIRO (VICE PRESIDENT)
(410) 832-7790
Entity
Organization
Contact information
Practice address
1785 S HAYES ST, ARLINGTON, VA 22202
(703) 920-5700
(410) 543-8492
Mailing address
PO BOX 62946, BALTIMORE, MD 21264-2946
(410) 494-7607
(610) 925-7387
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036556400
—
DE
05
—
999320700
—
MD
01
—
B018
BCBS OF NATIONAL CAPITOL
DC
01
—
KQ54GE
BCBS OF MARYLAND GP #
MH
Enumeration date
06/24/2006
Last updated
08/05/2019
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