Provider Demographics
NPI:1982665725
Name:PENNOYER, JENNIFER W (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:PENNOYER
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 1:47 JOLLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3092
Mailing Address - Country:US
Mailing Address - Phone:860-243-3020
Mailing Address - Fax:860-243-3002
Practice Address - Street 1:47 JOLLEY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3092
Practice Address - Country:US
Practice Address - Phone:860-243-3020
Practice Address - Fax:860-243-3002
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT038483207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070000506Medicare ID - Type Unspecified
H18708Medicare UPIN