Provider Demographics
NPI:1184921066
Name:PENNI RUSSO-GOING, MD
Entity type:Organization
Organization Name:PENNI RUSSO-GOING, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNI
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-594-3671
Mailing Address - Street 1:12131 TARA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4205
Mailing Address - Country:US
Mailing Address - Phone:713-594-3671
Mailing Address - Fax:713-468-2297
Practice Address - Street 1:1635 NORTH LOOP W
Practice Address - Street 2:ATTN: PENNI RUSSO-GOING, MD
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1532
Practice Address - Country:US
Practice Address - Phone:713-594-3671
Practice Address - Fax:713-468-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty