Provider Demographics
NPI:1093892325
Name:PENNINGTON, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:PENNINGTON
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 1:3925 EMBASSY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1763
Mailing Address - Country:US
Mailing Address - Phone:330-668-4065
Mailing Address - Fax:330-668-4082
Practice Address - Street 1:3925 EMBASSY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-1763
Practice Address - Country:US
Practice Address - Phone:330-668-4065
Practice Address - Fax:330-668-4082
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.055319207XS0106X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH927788Medicaid
240006022OtherRAILROAD MEDICARE
OH0740343Medicare PIN
OH927788Medicaid
F06593Medicare UPIN