Provider Demographics
NPI:1073739256
Name:GEORGE D. GIANNOUKOS MD, PA
Entity Type:Organization
Organization Name:GEORGE D. GIANNOUKOS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIANNOUKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-737-4272
Mailing Address - Street 1:66 OMEGA DRIVE
Mailing Address - Street 2:BUIDING E
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-737-4272
Mailing Address - Fax:302-737-6730
Practice Address - Street 1:66 OMEGA DR
Practice Address - Street 2:BUIDING E
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2061
Practice Address - Country:US
Practice Address - Phone:302-737-4272
Practice Address - Fax:302-737-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty