Provider Demographics
NPI:1104061696
Name:GENESIS ELDERCARE PHYSICIAN SERVICES I LLC
Entity type:Organization
Organization Name:GENESIS ELDERCARE PHYSICIAN SERVICES I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TREGOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-543-8870
Mailing Address - Street 1:801 N SALISBURY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3624
Mailing Address - Country:US
Mailing Address - Phone:410-543-1957
Mailing Address - Fax:
Practice Address - Street 1:11 DAIRY LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2663
Practice Address - Country:US
Practice Address - Phone:540-371-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty