Provider Demographics
NPI:1790764025
Name:VANRENS, GERARD HENDRIK (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:HENDRIK
Last Name:VANRENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIK
Other - Middle Name:
Other - Last Name:VAN RENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1801 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5351
Mailing Address - Country:US
Mailing Address - Phone:910-254-2023
Mailing Address - Fax:910-254-0242
Practice Address - Street 1:1801 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5351
Practice Address - Country:US
Practice Address - Phone:910-254-2023
Practice Address - Fax:910-254-0242
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19231207W00000X
NC9701180207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQPA675Medicaid
NC790129CMedicaid
NC891108HMedicaid
NC013115OtherBCBS
NC1108HOtherBCBS
180038152OtherRR MEDICARE
SC192311Medicaid
NC2344447AMedicare ID - Type Unspecified
NC790129CMedicaid
180038152OtherRR MEDICARE
NC2248794CMedicare ID - Type Unspecified