Provider Demographics
NPI:1801814611
Name:GENNARO, VICTOR (DO)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:GENNARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 706
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0706
Mailing Address - Country:US
Mailing Address - Phone:603-481-8757
Mailing Address - Fax:603-238-2163
Practice Address - Street 1:103 BOULDER POINT DRIVE
Practice Address - Street 2:PLYMOUTH ORTHOPEDICS AND SPORTS MEDICINE CLINIC
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-536-1565
Practice Address - Fax:603-536-1200
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3164921OtherCIGNA
MAZ51935OtherANTHEM
NH18P031OtherMVP
NH0400634Y0NH02OtherANTHEM
NH158488245OtherTRICARE
NH3070671Medicaid
VT0019104OtherANTHEM
NH175805800OtherUS DEPARTMENT OF LABOR
NH200043876OtherRAILROAD MEDICARE
NH30005795Medicaid
NH4483620001OtherDMERC
VTORE2681Medicaid
NH5330990OtherCCN
NH200043876OtherRAILROAD MEDICARE
NH18P031OtherMVP
NHF61545Medicare UPIN