Provider Demographics
NPI:1932259819
Name:GENESIS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:GENESIS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MID LEVEL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:412-364-6120
Mailing Address - Street 1:121 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1341
Mailing Address - Country:US
Mailing Address - Phone:412-834-5751
Mailing Address - Fax:
Practice Address - Street 1:3601 MCKNIGHT EAST DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6400
Practice Address - Country:US
Practice Address - Phone:412-364-6120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002824L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA002824LOtherPA-C LICENSE NUMBER
PAMA002824LOtherPA-C LICENSE NUMBER