Provider Demographics
NPI:1508822925
Name:GENOVESE, VINCENT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:GENOVESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-377-0111
Mailing Address - Fax:270-377-0113
Practice Address - Street 1:440 HOPKINSVILLE ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1124
Practice Address - Country:US
Practice Address - Phone:270-377-0111
Practice Address - Fax:270-377-0113
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58998207X00000X
KY40710207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000867OtherBLUECHIP
MA713792OtherTUFTS
MA0901010OtherUNITED HEALTH
MA79983OtherUS HEALTH
KYP0039857OtherRAILROAD MEDICARE
MA3037843Medicaid
KY000000508863OtherANTHEM BLUE CROSS
MA0119098-003OtherCIGNA
KY7100003760Medicaid
MA17311OtherPILGRIM
KY000000508863OtherANTHEM BLUE CROSS
MAA59277Medicare UPIN
KY00023003Medicare PIN