Provider Demographics
NPI:1487656914
Name:DURANKO, GREGORY F (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:DURANKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD STE 250
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-533-6497
Mailing Address - Fax:614-544-6350
Practice Address - Street 1:303 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4601
Practice Address - Country:US
Practice Address - Phone:614-788-5000
Practice Address - Fax:614-788-5100
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003244363A00000X
OH50.005209RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002397AMedicaid
GA970027446OtherRAILROAD MEDICARE
S70625Medicare UPIN
GA100002397AMedicaid