Provider Demographics
NPI:1649200668
Name:BELGRAVE, GENEVIEVE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:M
Last Name:BELGRAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 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:915-533-8499
Mailing Address - Fax:915-544-4929
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000R73X6Medicaid
TXP000R73X6Medicaid
TXB21175Medicare UPIN