Healthcare Provider Details

I. General information

NPI: 1750346045
Provider Name (Legal Business Name): EPHIGENIA GIANNOUKOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EPHIGENIA KOUMATOS GIANNOUKOS M.D.

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 OMEGA DR BLDG E
NEWARK DE
19713-2061
US

IV. Provider business mailing address

66 OMEGA DR BLDG E
NEWARK DE
19713-2061
US

V. Phone/Fax

Practice location:
  • Phone: 302-892-3300
  • Fax: 302-892-9824
Mailing address:
  • Phone: 302-892-3300
  • Fax: 302-892-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0003971
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC1/0003971
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: