Provider Demographics
NPI:1013150267
Name:PENNYCOOKE, OWANO M (MD)
Entity type:Individual
Prefix:DR
First Name:OWANO
Middle Name:M
Last Name:PENNYCOOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:901 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-677-1091
Practice Address - Fax:732-431-4640
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2024-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08547000208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery