Provider Demographics
NPI:1457349615
Name:PENNANEN, MARIE FERNICOLA (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:FERNICOLA
Last Name:PENNANEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70626
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20813-0626
Mailing Address - Country:US
Mailing Address - Phone:301-656-9010
Mailing Address - Fax:301-656-9011
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1455
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-9010
Practice Address - Fax:601-656-9011
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC163922086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07199Medicare UPIN
DC000T28G65Medicare PIN