MEDICARE: PENNAN BARRY MD, MPH

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	207R00000X	Internal Medicine Physician	A92150	CA
2	207RI0200X	Infectious Disease Physician	A92150	CA

General Provider Information

NPI Number	:	1225293111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNAN BARRY MD, MPH

Provider Business Mailing Address
First Line	:	850 MARINA BAY PKWY
Second Line	:	BLDG P, SECOND FLOOR
City	:	RICHMOND
State	:	CA
Zip	:	94804-6403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 MARINA BAY PKWY
Second Line	:	BLDG P, SECOND FLOOR
City	:	RICHMOND
State	:	CA
Zip	:	94804-6403
Country	:	US
Telephone Number	:	510-620-3041
Fax Number	:

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	02/18/2011

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