Provider Demographics
NPI:1811993249
Name:PAHNKE, PENMAN, AND WHITNEY PA
Entity type:Organization
Organization Name:PAHNKE, PENMAN, AND WHITNEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:PAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-733-0404
Mailing Address - Street 1:4701 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 1340
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2055
Mailing Address - Country:US
Mailing Address - Phone:302-733-0404
Mailing Address - Fax:302-733-0556
Practice Address - Street 1:410 FOULK RD
Practice Address - Street 2:STE 200A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3802
Practice Address - Country:US
Practice Address - Phone:302-764-2380
Practice Address - Fax:302-764-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002136208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE253702Medicaid