Provider Demographics
NPI:1609880558
Name:CONSAGRA, GENINE (DO)
Entity Type:Individual
Prefix:
First Name:GENINE
Middle Name:
Last Name:CONSAGRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GENINE
Other - Middle Name:
Other - Last Name:CONSAGRA-RIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR # 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:
Practice Address - Street 1:410 MALCOLM DR
Practice Address - Street 2:SUITE C
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-857-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG81595Medicare UPIN