Provider Demographics
NPI:1619151685
Name:PENNOCK, ANDREW TENNANT (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TENNANT
Last Name:PENNOCK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE #210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CT
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-309-6303
Mailing Address - Fax:858-309-6301
Practice Address - Street 1:3030 CHILDRENS WAY
Practice Address - Street 2:STE 410
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4232
Practice Address - Country:US
Practice Address - Phone:858-966-6789
Practice Address - Fax:858-966-8519
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2011-11-02
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Provider Licenses
StateLicense IDTaxonomies
CAA90049207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery