Provider Demographics
NPI:1578698486
Name:GIANAKON, PAUL AUGUST (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AUGUST
Last Name:GIANAKON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 DETJEN DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-1910
Mailing Address - Country:US
Mailing Address - Phone:302-494-9596
Mailing Address - Fax:
Practice Address - Street 1:2021 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3038
Practice Address - Country:US
Practice Address - Phone:410-224-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00450882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51226Medicare UPIN
MD799RMedicare ID - Type Unspecified