Provider Demographics
NPI:1750313995
Name:GIANNOUKOS, GEORGE D (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:GIANNOUKOS
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 1:66 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2061
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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF32583Medicare UPIN