Individual provider Active NPI

Robert Gennaro, MD

  • Obstetrics & Gynecology Physician
  • Stamford, CT
National Provider Identifier
1669578175
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
028989 Issued in CT
Practice address
30 Shelburne Rd
OBGYN Associates, PC
Stamford, CT 06902-3628
Phone
(203) 276-7060
NPI assigned
Sep 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 028989 CT Primary

Addresses

Primary practice location

30 Shelburne Rd
OBGYN Associates, PC
Stamford, CT 06902-3628

Mailing address

12 Cambridge Dr
Credentials Xpress
Trumbull, CT 06611-4764

Other identifiers 1

IdentifierTypeStateIssuer
001289893MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101102000949 CT Practitioner - Obstetrics/Gynecology 1951595099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Obstetrics and GynecologyGroup PAC ID 6901052414, 5 clinicians

Practice addresses (Care Compare)

999 Summer St
Suite 401
Stamford, CT 06905-5513
Phone (203) 353-9099

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
028989CTMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Obstetrics and Gynecology PC Obstetrics & Gynecology CurrentSince Aug 16, 2012 Accepting new patients

Locations

999 Summer St
Ste 401
Stamford, CT 06905
Phone (203) 353-9099

999 Summer St
Stamford, CT 06905
Phone (203) 353-9099

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669578175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CAMBRIDGE DR",
            "address_2": "CREDENTIALS XPRESS",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066114764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SHELBURNE RD",
            "address_2": "OBGYN ASSOCIATES, PC",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069023628",
            "telephone_number": "203-276-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENNARO",
        "first_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "028989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001289893",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

Verify at the official NPI Registry.