Provider Demographics
NPI:1427054857
Name:PAHNKE, GREG RANDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:RANDOLPH
Last Name:PAHNKE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4701 OGLETOWN STANTON RD
Mailing Address - Street 2:STE 1340
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2055
Mailing Address - Country:US
Mailing Address - Phone:302-733-0404
Mailing Address - Fax:302-733-0556
Practice Address - Street 1:4701 OGLETOWN STANTON RD
Practice Address - Street 2:STE 1340
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2055
Practice Address - Country:US
Practice Address - Phone:302-733-0404
Practice Address - Fax:302-733-0556
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC100021362086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE96101Medicaid
DEB66396Medicare UPIN
DE96101Medicaid