Provider Demographics
NPI:1932164498
Name:CHODKOWSKI, GREGG (MSPT)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:CHODKOWSKI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 VEALE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4601
Mailing Address - Country:US
Mailing Address - Phone:302-477-0800
Mailing Address - Fax:302-477-0801
Practice Address - Street 1:1303 VEALE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4601
Practice Address - Country:US
Practice Address - Phone:302-477-0800
Practice Address - Fax:302-477-0801
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001313208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001040201Medicaid
DES97321OtherBCBS OF DE
DES97321Medicare UPIN
DE490492Medicare ID - Type Unspecified