Provider Demographics
NPI:1518943711
Name:BIESEK, GENESIO W (MD)
Entity Type:Individual
Prefix:
First Name:GENESIO
Middle Name:W
Last Name:BIESEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ELM ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1217
Mailing Address - Country:US
Mailing Address - Phone:603-622-4200
Mailing Address - Fax:603-626-7987
Practice Address - Street 1:1650 ELM ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1217
Practice Address - Country:US
Practice Address - Phone:603-622-4200
Practice Address - Fax:603-626-7987
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH7536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002125Medicaid
NHNH9431Medicare ID - Type Unspecified