Individual
JOHN T GENECZKO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 TRENT DR, 3662 DUMC, DURHAM, NC 27710-2479
(919) 684-1817
(919) 681-8147
Mailing address
PO BOX 3662, DURHAM, NC 27710-0001
(919) 684-1817
(919) 681-8147
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01036161A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190914
ANTHEM PROVIDER NUMBER
IN
05
—
100085880
—
IN
01
—
10825131
CAQH NUMBER
IN
01
—
9397086
PHCS PID NUMBER
IN
05
—
GE15365010
—
IN
Enumeration date
03/15/2006
Last updated
05/28/2013
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