Healthcare Provider Details

I. General information

NPI: 1093892325
Provider Name (Legal Business Name): GARY A. PENNINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 EMBASSY PKWY STE 300
AKRON OH
44333-1763
US

IV. Provider business mailing address

3925 EMBASSY PKWY STE 300
AKRON OH
44333-1763
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4065
  • Fax: 330-668-4082
Mailing address:
  • Phone: 330-668-4065
  • Fax: 330-668-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35.055319
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.055319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: