Provider Demographics
NPI:1114039286
Name:GENOVESE, JOSEPH JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:GENOVESE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:12510 PROSPERITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1663
Mailing Address - Country:US
Mailing Address - Phone:240-485-5200
Mailing Address - Fax:301-625-6906
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-593-2002
Practice Address - Fax:301-583-4781
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MDD0035087207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0035087OtherSTATE LICENSE
MDM24743OtherCDS NUMBER
MD209381200Medicaid
MD209381200Medicaid
DC004622G74Medicare PIN
MDAG2511144OtherDEA LICENSE NUMBER