Provider Demographics
NPI:1457313363
Name:GENGE, MILAN R (DO)
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:R
Last Name:GENGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MEDICAL PK DR W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2788
Mailing Address - Country:US
Mailing Address - Phone:252-291-7008
Mailing Address - Fax:252-291-1281
Practice Address - Street 1:1707 MEDICAL PARK DR W
Practice Address - Street 2:SUITE 1
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2788
Practice Address - Country:US
Practice Address - Phone:252-291-7008
Practice Address - Fax:252-291-1281
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00746152WV0400X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902056Medicaid
NC2042545Medicare ID - Type Unspecified
NC5902056Medicaid