Provider Demographics
NPI:1861493249
Name:HALLIDAY, PENELOPE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:ANN
Last Name:HALLIDAY
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 1:403 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CH
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1433
Mailing Address - Country:US
Mailing Address - Phone:740-335-0741
Mailing Address - Fax:740-335-9473
Practice Address - Street 1:403 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON CH
Practice Address - State:OH
Practice Address - Zip Code:43160-1433
Practice Address - Country:US
Practice Address - Phone:740-335-0741
Practice Address - Fax:740-335-9473
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-5762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0100000118785OtherANTHEM BCBS
0103041OtherUNITED HEALTHCARE
12818OtherCIGNA
0103041OtherUNITED HEALTHCARE
A80116Medicare UPIN
0500104Medicare PIN