Healthcare Provider Details

I. General information

NPI: 1811993249
Provider Name (Legal Business Name): PAHNKE, PENMAN, AND WHITNEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

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

410 FOULK RD STE 200A
WILMINGTON DE
19803-3802
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 302-764-2380
  • Fax: 302-764-3501
Mailing address:
  • Phone: 302-733-0404
  • Fax: 302-733-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC10002136
License Number StateDE

VIII. Authorized Official

Name: DR. GREG RANDOLPH PAHNKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-733-0404