Provider Demographics
NPI:1639172703
Name:PENNELL, REBECCA G (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:G
Last Name:PENNELL
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 4216
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4216
Mailing Address - Country:US
Mailing Address - Phone:717-394-6028
Mailing Address - Fax:717-509-6362
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-394-6028
Practice Address - Fax:717-394-9223
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026373E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA430969YYYOtherMEDICARE PTAN
PA231855378OtherTAX ID - LANC RADIOLOGY
PA23-3102793OtherTAX ID - LANCASTER PET IMAGING
PA300047049OtherRAILROAD MEDICARE
PA33-1011386OtherTAX ID - MRI GROUP
PA231855378OtherTAX ID - LANC RADIOLOGY
PA300047049OtherRAILROAD MEDICARE