Provider Demographics
NPI:1326128786
Name:MILTON ENTERPRISES, INC
Entity Type:Organization
Organization Name:MILTON ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-684-2000
Mailing Address - Street 1:16529 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3605
Mailing Address - Country:US
Mailing Address - Phone:302-684-2000
Mailing Address - Fax:302-644-6860
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-684-2000
Practice Address - Fax:302-644-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1326128786OtherMEDICAID GROUP
DE1992792717OtherMEDICAID DR WAGNER
DE003996M35Medicare ID - Type UnspecifiedDR CHARLES G. WAGNER
DE1326128786OtherMEDICAID GROUP
DE1992792717OtherMEDICAID DR WAGNER
DE=========OtherBLUE CROSS OF DE
DEE69200Medicare UPIN
DE1000024596Medicaid
DE0000306301Medicaid
DE0000306302Medicaid
DE003996M35Medicare ID - Type UnspecifiedDR CHARLES G. WAGNER
DE010021M35Medicare ID - Type UnspecifiedDR. JULIE HOLMON
DEP00060869Medicare ID - Type UnspecifiedRAILROAD - DR. J. HOLMON