Provider Demographics
NPI:1568434298
Name:GENERETTE, PASHA (MD)
Entity Type:Individual
Prefix:
First Name:PASHA
Middle Name:
Last Name:GENERETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST OLNEY AVE
Mailing Address - Street 2:505
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 PENN BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1416
Practice Address - Country:US
Practice Address - Phone:215-848-8800
Practice Address - Fax:215-848-6036
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039259L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001489863007Medicaid
PA001489863007Medicaid
B41992Medicare UPIN