Healthcare Provider Details

I. General information

NPI: 1427054857
Provider Name (Legal Business Name): GREG RANDOLPH PAHNKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 1340
NEWARK DE
19713-2055
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD STE 1340
NEWARK DE
19713-2055
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-0404
  • Fax: 302-733-0556
Mailing address:
  • Phone: 302-733-0404
  • Fax: 302-733-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberC10002136
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: