Provider Demographics
NPI:1891756748
Name:GENVERT, HAROLD I (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:I
Last Name:GENVERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1342 SOUTH DIVISION STREET
Mailing Address - Street 2:UNIT 401
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21084
Mailing Address - Country:US
Mailing Address - Phone:410-546-2133
Mailing Address - Fax:410-548-3361
Practice Address - Street 1:1342 SOUTH DIVISION STREET
Practice Address - Street 2:UNIT 401
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21084
Practice Address - Country:US
Practice Address - Phone:410-546-2133
Practice Address - Fax:410-548-3361
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD34976208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444681000Medicaid
MDH831Medicare ID - Type Unspecified
MD444681000Medicaid
MD340005579Medicare PIN