Provider Demographics
NPI:1043454648
Name:GENEVIEVE M, BELGRAVE, M.D. PA
Entity Type:Organization
Organization Name:GENEVIEVE M, BELGRAVE, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-204-0526
Mailing Address - Street 1:7712 GRAND CANYON PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3140
Mailing Address - Country:US
Mailing Address - Phone:915-204-0526
Mailing Address - Fax:915-779-0440
Practice Address - Street 1:1316 N YARBROUGH DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7800
Practice Address - Country:US
Practice Address - Phone:915-590-7378
Practice Address - Fax:915-590-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649200668OtherINDIVIDUAL NPI