Provider Demographics
NPI:1710071287
Name:BATES, GENEVIEVE C (MD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:C
Last Name:BATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3964 HAMILTON SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9119
Mailing Address - Country:US
Mailing Address - Phone:614-834-6800
Mailing Address - Fax:614-834-6980
Practice Address - Street 1:7265 BROMFIELD DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8236
Practice Address - Country:US
Practice Address - Phone:614-834-6980
Practice Address - Fax:614-834-6980
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066224B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978625Medicaid
OH0978625Medicaid