Provider Demographics
NPI:1740483429
Name:PENNYE DOUD & ASSOCIATES, PC
Entity type:Organization
Organization Name:PENNYE DOUD & ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-266-0099
Mailing Address - Street 1:130 HOLIDAY CT
Mailing Address - Street 2:STE 109
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7003
Mailing Address - Country:US
Mailing Address - Phone:410-266-0099
Mailing Address - Fax:410-266-8629
Practice Address - Street 1:130 HOLIDAY CT
Practice Address - Street 2:STE 109
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7003
Practice Address - Country:US
Practice Address - Phone:410-266-0099
Practice Address - Fax:410-266-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLW79OtherBCBS GROUP
MDX594Medicare ID - Type UnspecifiedMEDICARE GROUP