MEDICARE: DR. THOMAS E PENN MD

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	174400000X	Specialist	116335	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700802832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E PENN MD

Provider Business Mailing Address
First Line	:	919 WESTFALL RD STE B100
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2628
Country	:	US
Telephone Number	:	585-454-6610
Fax Number	:	585-454-6564

Provider Business Practice Location Address
First Line	:	919 WESTFALL RD STE B100
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2628
Country	:	US
Telephone Number	:	585-454-6610
Fax Number	:	585-454-6564

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	02/14/2012

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