Healthcare Provider Details

I. General information

NPI: 1487623906
Provider Name (Legal Business Name): MICHAEL W. GEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONSTITUTION DR STE 217
VIRGINIA BEACH VA
23462-6799
US

IV. Provider business mailing address

100 CONSTITUTION DR STE 217
VIRGINIA BEACH VA
23462-6799
US

V. Phone/Fax

Practice location:
  • Phone: 757-963-7729
  • Fax: 757-470-5665
Mailing address:
  • Phone: 757-963-7729
  • Fax: 757-470-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101265990
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101265990
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101265990
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number0101265990
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: