Provider Demographics
NPI:1073581039
Name:PENROD, LOUIS EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:EDMUND
Last Name:PENROD
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 1:3471 FIFTH AVENUE SUITE 201
Mailing Address - Street 2:LILLIAN KAUFMANN BUILDING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-692-4070
Mailing Address - Fax:
Practice Address - Street 1:3471 5TH AVE
Practice Address - Street 2:LILLIAN KAUFMANN BUILDING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3209
Practice Address - Country:US
Practice Address - Phone:412-692-4070
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035379E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC75714Medicare UPIN
PA685155JX3Medicare ID - Type Unspecified