Provider Demographics
NPI:1679534770
Name:CHENG, GENE (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MIDDLE STREET
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-622-4400
Mailing Address - Fax:207-621-2483
Practice Address - Street 1:6 MIDDLE STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-622-4400
Practice Address - Fax:207-621-2483
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME405500000Medicaid
047014OtherANTHEM
2350502OtherAETNA
ME0533Medicare ID - Type Unspecified
ME405500000Medicaid