Provider Demographics
NPI:1255386009
Name:PENN, MARSHA K (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:K
Last Name:PENN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:715 SHAKER DR
Mailing Address - Street 2:STE 120
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504
Mailing Address - Country:US
Mailing Address - Phone:859-278-8443
Mailing Address - Fax:859-278-6325
Practice Address - Street 1:715 SHAKER DR
Practice Address - Street 2:STE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-278-8443
Practice Address - Fax:859-278-6325
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22793207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227936Medicaid
KY000000068914OtherBLUE CROSS BLUE SHIELD
KYC69340Medicare UPIN
KY64227936Medicaid