Charles Raymond Genovese Jr., M.D.
Individual provider Active NPI Internal Medicine Physician · Independence, LA
NPI 1891719985 · NPPES record last updated Dec 27, 2024
Key facts
- NPI
- 1891719985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD.015669 (LA)
- Practice address
- 312 East Railroad Avenue
Independence, LA 70443 - Phone
- (985) 878-4183
- Fax
- (985) 878-3830
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015669 | LA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| First Down Healthcare | Current |
Accepting new patients |
Locations
3926 Barron St
Ste C210
Metairie, LA 70002
Phone (504) 887-3142
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 015669 | LA | |
| Internal Medicine Physician | 207R00000X | MD.015669 | LA | Yes |
Addresses
Primary practice location
312 East Railroad Avenue
Independence, LA 70443
Mailing address
3926 Barron St Ste C210
Metairie, LA 70002-5798
Phone (504) 887-3142
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1335681 | Medicaid | LA |
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All providers in Independence, LA · Internal Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.