Provider Demographics
NPI:1518026053
Name:GREGORY PENNER, MD
Entity Type:Organization
Organization Name:GREGORY PENNER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-721-0911
Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-721-0911
Mailing Address - Fax:207-721-9729
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-721-0911
Practice Address - Fax:207-721-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty