Individual
GENTA BACI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
825 FAIRFAX AVE STE 118, NORFOLK, VA 23507-1914
(757) 446-5951
Mailing address
825 FAIRFAX AVE STE 118, NORFOLK, VA 23507-1914
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101277505
VA
207Q00000X
Family Medicine Physician
237215
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110080415A
—
MA
Enumeration date
12/05/2007
Last updated
03/02/2023
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