Provider Demographics
NPI:1851381065
Name:GENOVESE, RICHARD E (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GENOVESE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LAKE ST STE 151
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3889
Mailing Address - Country:US
Mailing Address - Phone:978-632-5722
Mailing Address - Fax:978-630-3240
Practice Address - Street 1:31 LAKE ST
Practice Address - Street 2:SUITE 151
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3889
Practice Address - Country:US
Practice Address - Phone:978-632-5722
Practice Address - Fax:978-630-3240
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1652213ES0103X
MA1625213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0341975Medicaid
MAY70701Medicare PIN
T25731Medicare UPIN
MA0341975Medicaid