Healthcare Provider Details

I. General information

NPI: 1942287313
Provider Name (Legal Business Name): MARCUS L PENN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 306
ANNAPOLIS MD
21401-3745
US

IV. Provider business mailing address

2003 MEDICAL PKWY SUITE 370
ANNAPOLIS MD
21401-7992
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9700
  • Fax: 410-571-9710
Mailing address:
  • Phone: 410-571-9700
  • Fax: 410-571-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0043531
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0043531
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: