Provider Demographics
NPI:1356518468
Name:SKALAK, GENEVIEVE M (DO)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:M
Last Name:SKALAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:
Practice Address - Street 1:2705 DEKALB PIKE
Practice Address - Street 2:SUITE 309
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1874
Practice Address - Country:US
Practice Address - Phone:610-275-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014167207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9269342OtherAETNA
P00745518OtherRAILROAD MEDICARE
SK2106495OtherBLUE SHIELD
PA1023225990001Medicaid
30065304OtherKEYSTONE MERCY
3718325000OtherIBC/KHPE
9269342OtherAETNA