Provider Demographics
NPI:1700021250
Name:GENESIS ELDERCARE PHYSICIAN SERVICES I LLC
Entity Type:Organization
Organization Name:GENESIS ELDERCARE PHYSICIAN SERVICES I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIOSN
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TREGOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-543-8870
Mailing Address - Street 1:801 N SALISBURY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3624
Mailing Address - Country:US
Mailing Address - Phone:410-543-1957
Mailing Address - Fax:
Practice Address - Street 1:801 N SALISBURY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3624
Practice Address - Country:US
Practice Address - Phone:410-543-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty