MEDICARE: DR. GENEVIEVE A LOGIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101238671	VA
2	207R00000X	Internal Medicine Physician	C139040	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00321250	OTHER	VA	RAILROAD MEDICARE
7	P00283213	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06778	OTHER	VA	GROUP PTAN
2	188196	OTHER	VA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	185382	OTHER	VA	BCBS

General Provider Information

NPI Number	:	1215909437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENEVIEVE A LOGIE MD

Provider Business Mailing Address
First Line	:	1001 RIVERSIDE AVE
Second Line	:	MOTT BUILDING, MEDICINE-2
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5134
Country	:	US
Telephone Number	:	916-936-5380
Fax Number	:	916-746-4553

Provider Business Practice Location Address
First Line	:	1001 RIVERSIDE AVE
Second Line	:	MOTT BUILDING, MEDICINE-2
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5134
Country	:	US
Telephone Number	:	916-936-5380
Fax Number	:	916-746-4553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	01/10/2022

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Directions to “ DR. GENEVIEVE A LOGIE MD” Practice Location

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