Provider Demographics
NPI:1215909437
Name:LOGIE, GENEVIEVE A (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:A
Last Name:LOGIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GENEVIEVE
Other - Middle Name:A
Other - Last Name:GATMAITAN-LOGIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1001 RIVERSIDE AVE
Mailing Address - Street 2:MOTT BUILDING, MEDICINE-2
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5134
Mailing Address - Country:US
Mailing Address - Phone:916-936-5380
Mailing Address - Fax:916-746-4553
Practice Address - Street 1:1001 RIVERSIDE AVE
Practice Address - Street 2:MOTT BUILDING, MEDICINE-2
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5134
Practice Address - Country:US
Practice Address - Phone:916-936-5380
Practice Address - Fax:916-746-4553
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238671207R00000X
CAC139040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VA188196OtherBCBS
VA010236711Medicaid
VA010236746Medicaid
VAP00321250OtherRAILROAD MEDICARE
VA185382OtherBCBS
VAP00283213OtherRAILROAD MEDICARE
VA188196OtherBCBS
VA010236746Medicaid
VAI46982Medicare UPIN