MEDICARE: DR. GREG RANDOLPH PAHNKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	C10002136	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427054857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREG RANDOLPH PAHNKE M.D.

Provider Business Mailing Address
First Line	:	4701 OGLETOWN STANTON RD
Second Line	:	STE 1340
City	:	NEWARK
State	:	DE
Zip	:	19713-2055
Country	:	US
Telephone Number	:	302-733-0404
Fax Number	:	302-733-0556

Provider Business Practice Location Address
First Line	:	4701 OGLETOWN STANTON RD
Second Line	:	STE 1340
City	:	NEWARK
State	:	DE
Zip	:	19713-2055
Country	:	US
Telephone Number	:	302-733-0404
Fax Number	:	302-733-0556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/21/2014

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