Provider Demographics
NPI:1841253309
Name:PENNINGTON, ROBERT EDWARD JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:PENNINGTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR
Mailing Address - Street 2:EH 523
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5125
Mailing Address - Country:US
Mailing Address - Phone:317-278-1293
Mailing Address - Fax:317-278-6523
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EH 523
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5125
Practice Address - Country:US
Practice Address - Phone:317-278-1293
Practice Address - Fax:317-278-6523
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN1027380A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233690TMedicare ID - Type Unspecified
D95083Medicare UPIN