MEDICARE: DR. KAREN J PENTELLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	35.123128	OH

General Provider Information

NPI Number	:	1124102439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN J PENTELLA M.D.

Provider Business Mailing Address
First Line	:	5300 NORTH MEADOWS DRIVE
Second Line	:	BUILDING 1, SUITE 140
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2546
Country	:	US
Telephone Number	:	614-627-1620
Fax Number	:	614-224-4428

Provider Business Practice Location Address
First Line	:	5300 NORTH MEADOWS DRIVE
Second Line	:	BUILDING 1, SUITE 140
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2546
Country	:	US
Telephone Number	:	614-627-1620
Fax Number	:	614-224-4428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/30/2021

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