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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
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