Provider Demographics
NPI:1598757940
Name:HAHN, PENNY LEUE (MD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LEUE
Last Name:HAHN
Suffix:
Gender:F
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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-0194
Mailing Address - Country:US
Mailing Address - Phone:513-899-2931
Mailing Address - Fax:513-899-4653
Practice Address - Street 1:158 E PIKE ST
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152
Practice Address - Country:US
Practice Address - Phone:513-899-2931
Practice Address - Fax:513-899-4653
Is Sole Proprietor?:No
Enumeration Date:2005-08-20
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061564208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000017310OtherBLUE CROSS
OH0882684Medicaid
OHHA0696412Medicare PIN
E92256Medicare UPIN