1215909437 NPI number — DR. GENEVIEVE A LOGIE MD

Table of content: DR. GENEVIEVE A LOGIE MD (NPI 1215909437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215909437 NPI number — DR. GENEVIEVE A LOGIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOGIE
Provider First Name:
GENEVIEVE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GATMAITAN-LOGIE
Provider Other First Name:
GENEVIEVE
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215909437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 RIVERSIDE AVE
Provider Second Line Business Mailing Address:
MOTT BUILDING, MEDICINE-2
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95678-5134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-936-5380
Provider Business Mailing Address Fax Number:
916-746-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
MOTT BUILDING, MEDICINE-2
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95678-5134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-936-5380
Provider Business Practice Location Address Fax Number:
916-746-4553
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101238671 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: C139040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C06778 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 188196 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010236711 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010236746 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00321250 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 185382 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00283213 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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