MEDICARE: ROBERT EDWARD PENNINGTON JR. 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	208600000X	Surgery Physician	1027380A	IN

General Provider Information

NPI Number	:	1841253309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EDWARD PENNINGTON JR. MD

Provider Business Mailing Address
First Line	:	545 BARNHILL DR
Second Line	:	EH 523
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5125
Country	:	US
Telephone Number	:	317-278-1293
Fax Number	:	317-278-6523

Provider Business Practice Location Address
First Line	:	545 BARNHILL DR
Second Line	:	EH 523
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5125
Country	:	US
Telephone Number	:	317-278-1293
Fax Number	:	317-278-6523

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	10/05/2010

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