Provider Demographics
NPI:1861460636
Name:RACZNIAK, GREGORY AARON (MD, PHD, MPHIL)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:AARON
Last Name:RACZNIAK
Suffix:
Gender:M
Credentials:MD, PHD, MPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORAL SEA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3693
Mailing Address - Country:US
Mailing Address - Phone:808-682-2673
Mailing Address - Fax:808-682-2779
Practice Address - Street 1:1 CORAL SEA ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3693
Practice Address - Country:US
Practice Address - Phone:808-682-2673
Practice Address - Fax:808-682-2779
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238610208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR9394494OtherFDA LICENSE