Provider Demographics
NPI:1255365417
Name:GENNARO, MARY-CATHERINE (DO)
Entity type:Individual
Prefix:
First Name:MARY-CATHERINE
Middle Name:
Last Name:GENNARO
Suffix:
Gender:F
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-0032
Mailing Address - Country:US
Mailing Address - Phone:603-735-6060
Mailing Address - Fax:877-521-6764
Practice Address - Street 1:16 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1126
Practice Address - Country:US
Practice Address - Phone:603-536-1881
Practice Address - Fax:603-238-2198
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV742626876OtherCIGNA
NH742626876OtherCBA
NH30006160Medicaid
NH04YP07578NH02OtherANTHEM
NHE28333Medicare UPIN
NH30006160Medicaid