Provider Demographics
NPI:1205801735
Name:PASCUAL, GENEROSO SANTOS (MD)
Entity type:Individual
Prefix:DR
First Name:GENEROSO
Middle Name:SANTOS
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 5TH AVE
Mailing Address - Street 2:A LEVEL MANSFIELD
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2422
Mailing Address - Country:US
Mailing Address - Phone:412-664-2507
Mailing Address - Fax:
Practice Address - Street 1:1500 5TH AVE
Practice Address - Street 2:A LEVEL MANSFIELD
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2422
Practice Address - Country:US
Practice Address - Phone:412-664-2507
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036068L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB96785Medicare UPIN
PA046411G89Medicare ID - Type Unspecified