Provider Demographics
NPI:1841269180
Name:REGNIER, DAVID PENNINGTON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PENNINGTON
Last Name:REGNIER
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:550 S HOKE AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-2664
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-659-2577
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045380A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397381OtherPHCS PID NUMBER
IN10825814OtherCAQH NUMBER
IN200131040Medicaid
IN000000315113OtherANTHEM FP PROVIDER NUMBER
IN000000393549OtherANTHEM UC PROVIDER NUMBER
IN815510KMedicare PIN
IN815520SMedicare PIN
IN090680OMedicare PIN
IN8155000HHHMedicare PIN
IN000000315113OtherANTHEM FP PROVIDER NUMBER
IN000000393549OtherANTHEM UC PROVIDER NUMBER
IN142080MMMedicare PIN
IN142090SMedicare PIN