Individual
GLENN P GENEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3455 MAIN ST, SUITE 5, SPRINGFIELD, MA 01107-1147
(413) 733-9600
(413) 732-6534
Mailing address
3455 MAIN ST, SUITE 5, SPRINGFIELD, MA 01107-1147
(413) 733-9600
(413) 732-6534
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
219834
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219834J597
CONNECTICARE
CT
01
—
34234
HEALTH NEW ENGLAND
MA
01
—
468903
TUFTS HEALTH PLANS
MA
01
—
GEJ27216
BLUE CROSS BLUE SHIELD
MA
01
—
P00181345
RAILROAD MEDICARE
—
Enumeration date
07/08/2005
Last updated
11/08/2007
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