| Genesis Eldercare Physician Services LLC | |
|
11 Dairy Ln Fredericksburg VA 22405-2663 | |
| (540) 371-9414 | |
| Not Available |
| Full Name | Genesis Eldercare Physician Services LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 11 Dairy Ln, Fredericksburg, Virginia |
| Authorized Official Name and Position | Eric Shapiro (VP, CONTROLLER) |
| Authorized Official Contact | 4108327790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Eldercare Physician Services LLC 801 N Salisbury Blvd Suite 201 Salisbury MD 21801-3624 Ph: (410) 494-7607 | Genesis Eldercare Physician Services LLC 11 Dairy Ln Fredericksburg VA 22405-2663 Ph: (540) 371-9414 |
| NPI Number | 1699710202 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 9830002534 |
|---|---|
| Medicare Enrollment ID | O20031121000600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699710202 | NPI | - | NPPES |
| B018 | Other | DC | BCBS OF NATIONAL CAPITOL |
| 036556400 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | () | Secondary |
| Provider Name | Getachew Y Woldeher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073504940 PECOS PAC ID: 0749170975 Enrollment ID: I20040319000317 |
| Provider Name | Khalil a Amir |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1437179405 PECOS PAC ID: 7416950654 Enrollment ID: I20060809000097 |
| Provider Name | Amy B Alvis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1144253394 PECOS PAC ID: 3375549611 Enrollment ID: I20080115000841 |
| Provider Name | Rachel Brittany Ambrose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952829665 PECOS PAC ID: 2668739095 Enrollment ID: I20171120002161 |
| Provider Name | Jennifer P Reluya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801562988 PECOS PAC ID: 6507250156 Enrollment ID: I20220225000503 |
| Provider Name | Summit Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942485321 PECOS PAC ID: 6406931674 Enrollment ID: I20231122001137 |
| Provider Name | Ahsan Afzal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316263692 PECOS PAC ID: 1052553914 Enrollment ID: I20250328003465 |
| Provider Name | Quartel-ayne Amjad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760701437 PECOS PAC ID: 1658564489 Enrollment ID: I20251029004781 |
| Provider Name | Rebekah Jordan Louthen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073324406 PECOS PAC ID: 3971081977 Enrollment ID: I20260131000233 |
| Provider Name | Janne L Nicholson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033737440 PECOS PAC ID: 7315367141 Enrollment ID: I20260414001501 |
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