Provider Demographics
NPI:1326287855
Name:PEVNY, ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:PEVNY
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 1:47 SMITHFIELD VLG
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9054
Mailing Address - Country:US
Mailing Address - Phone:570-421-2571
Mailing Address - Fax:
Practice Address - Street 1:47 SMITHFIELD VLG
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9054
Practice Address - Country:US
Practice Address - Phone:570-421-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030407E207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine