1881635183 NPI number — GENESIS ELDERCARE PHYSICIAN SERVICES LLC

Table of content: LIZA FRANCESCA GLIFONEA FELIX PT (NPI 1770333064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881635183 NPI number — GENESIS ELDERCARE PHYSICIAN SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881635183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62946
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-494-7607
Provider Business Mailing Address Fax Number:
610-925-7387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6508 DEER POINTE DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-543-1957
Provider Business Practice Location Address Fax Number:
410-543-8942
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, CONTROLLER
Authorized Official Telephone Number:
410-832-7790

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 999320700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999320705 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: B018 . This is a "CAREFIRST BCBS OF NCA GP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: KQ54GE . This is a "CAREFIRST BCBS OF MD GP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com