Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | C10002136 | DE |
NPI | 1427054857 |
---|---|
Provider Name | Dr. Greg Randolph Pahnke |
First Address | Newark, DE 19713-2055 |
Second Address | Newark, DE 19713-2055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
96101 | (05) | DE |
B66396 | (02) | DE |