Healthcare Provider Details

I. General information

NPI: 1861493249
Provider Name (Legal Business Name): PENELOPE ANN HALLIDAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E MARKET ST
WASHINGTON CH OH
43160-1433
US

IV. Provider business mailing address

403 E MARKET ST
WASHINGTON CH OH
43160-1433
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-0741
  • Fax: 740-335-9473
Mailing address:
  • Phone: 740-335-0741
  • Fax: 740-335-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-04-5762
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: