Provider Demographics
NPI:1366702805
Name:GENOVESE, LEONARD D (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:D
Last Name:GENOVESE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MEDICAL CENTER DR STE 3100
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2672
Mailing Address - Country:US
Mailing Address - Phone:207-729-7939
Mailing Address - Fax:207-808-7894
Practice Address - Street 1:121 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2653
Practice Address - Country:US
Practice Address - Phone:207-373-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD044175207R00000X
MEMD27061207RA0001X, 207R00000X, 207RC0000X, 207UN0901X
VA0101267410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology