Organization
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Active
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
11 DAIRY LN, FREDERICKSBURG, VA 22405-2663
(540) 371-9414
Mailing address
801 N SALISBURY BLVD, SUITE 201, SALISBURY, MD 21801-3624
(410) 494-7607
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
—
DC
01
—
B018
BCBS OF NATIONAL CAPITOL
DC
Enumeration date
06/18/2006
Last updated
08/05/2019
Update your record
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