Healthcare Provider Details

I. General information

NPI: 1457349615
Provider Name (Legal Business Name): MARIE FERNICOLA PENNANEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVE SUITE 1455
CHEVY CHASE MD
20815-4404
US

IV. Provider business mailing address

PO BOX 70626
BETHESDA MD
20813-0626
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-9010
  • Fax: 601-656-9011
Mailing address:
  • Phone: 301-656-9010
  • Fax: 301-656-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number16392
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: