Provider Demographics
NPI:1881670719
Name:PENNINGTON, BRENT E (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:E
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4908
Mailing Address - Country:US
Mailing Address - Phone:615-327-9797
Mailing Address - Fax:615-613-0329
Practice Address - Street 1:2301 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4908
Practice Address - Country:US
Practice Address - Phone:615-327-9797
Practice Address - Fax:615-613-0329
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39587207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI05656Medicare UPIN
TN3330205Medicare ID - Type Unspecified