Provider Demographics
NPI:1730370255
Name:PENNANT, MARJORIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:PENNANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-0001
Mailing Address - Country:US
Mailing Address - Phone:410-328-8040
Mailing Address - Fax:443-462-3514
Practice Address - Street 1:827 LINDEN AVE
Practice Address - Street 2:FLOOR 2, SOUTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4606
Practice Address - Country:US
Practice Address - Phone:443-682-6800
Practice Address - Fax:443-552-2991
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61595207RE0101X, 207RE0101X
PAMT185634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405736800Medicaid
MD9783-0020OtherCAREFIRST BC/BS
MD405736800Medicaid