Provider Demographics
NPI:1609841113
Name:MARCHETTI, PENNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNIE
Middle Name:
Last Name:MARCHETTI
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 1:1355B CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4432
Mailing Address - Country:US
Mailing Address - Phone:330-653-3157
Mailing Address - Fax:330-653-3170
Practice Address - Street 1:1355B CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4432
Practice Address - Country:US
Practice Address - Phone:330-653-3157
Practice Address - Fax:330-653-3170
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-18
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-063489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0876931Medicaid
OHMA0717265Medicare PIN
OH9335381Medicare PIN
OH0876931Medicaid