Provider Demographics
NPI:1831118108
Name:PENNISSON, ANNE MARIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARIAN
Last Name:PENNISSON
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 3597
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39521-3597
Mailing Address - Country:US
Mailing Address - Phone:228-467-9877
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:DEPARTMENT OF MEDICINE BILOXI VA (111)
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5000
Practice Address - Fax:228-523-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL26110OtherMEDICAL LICENSE
LA20649OtherMEDICAL LICENSE
SC26749OtherMEDICAL LICENSE
SCF19139Medicare UPIN