Provider Demographics
NPI:1720080476
Name:PENNINGTON, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-348-4242
Mailing Address - Fax:860-348-4646
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-348-4242
Practice Address - Fax:860-348-4646
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043011207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00311000OtherRAIL ROAD MEDICARE ID
CT1255448155OtherGHMC GROUP NPI ID
CT5713161OtherCIGNA
CT043011OtherCONNECTICARE
CT3961986OtherAETNA
CT368233OtherWELLCARE MEDICARE
CT010043011CT01OtherBCBS & BCFP ID
CT2V6529OtherHEALTH NET
CTP3616072OtherOXFORD
CTC01373Medicare ID - Type UnspecifiedGHMC GROUP MEDICARE ID
CTP3616072OtherOXFORD