Provider Demographics
NPI:1013953991
Name:PIANKA, GRETCHEN A (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:PIANKA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:A
Other - Last Name:HUOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:180 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2957
Mailing Address - Country:US
Mailing Address - Phone:207-874-2141
Mailing Address - Fax:207-874-2164
Practice Address - Street 1:180 PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2927
Practice Address - Country:US
Practice Address - Phone:207-874-2141
Practice Address - Fax:207-874-2164
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00204198OtherRAILROAD MEDICARE
ME411940099Medicaid
MEP00204198OtherRAILROAD MEDICARE
I14532Medicare UPIN
ME411940099Medicaid