# BELLGRADE MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bellgrade Medical, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326546151
- **Authorized official:** DR. PETER GENT (PRESIDENT)
- **Authorized official phone:** (804) 598-4799

## Contact information

- **Practice address:** 2621 PROMENADE PKWY STE 101, MIDLOTHIAN, VA 23113-4905
- **Practice address phone:** (804) 897-3746
- **Mailing address:** 2621 PROMENADE PKWY STE 101, MIDLOTHIAN, VA 23113-4905
- **Mailing address phone:** (804) 897-3746

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0102032395 | VA | Yes |

## Other

- **Enumeration date:** 01/26/2018
- **Last updated:** 04/04/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0102032395 | STATE LICENSE | VA |