Provider Demographics
NPI:1306031612
Name:ROBERT R PENNELL MD PC
Entity Type:Organization
Organization Name:ROBERT R PENNELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-593-5430
Mailing Address - Street 1:225 BOSTON STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904
Mailing Address - Country:US
Mailing Address - Phone:781-593-5430
Mailing Address - Fax:781-593-6149
Practice Address - Street 1:225 BOSTON STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904
Practice Address - Country:US
Practice Address - Phone:781-593-5430
Practice Address - Fax:781-593-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36534207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9722092Medicaid
M13460Medicare PIN
A54148Medicare UPIN