Individual
DR. GREGORY K. WANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, PA-C
Contact information
Practice address
4755 OGLETOWN STANTON RD, NEWARK, DE 19718-2200
(302) 733-1840
Mailing address
PO BOX 7529, NEWARK, DE 19714-7529
(302) 294-1468
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C2-0011617
DE
363A00000X
Physician Assistant
25MP00150600
NJ
390200000X
Student in an Organized Health Care Education/Training Program
OT015368
PA
Other
Enumeration date
07/11/2006
Last updated
10/19/2018
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