Gerald Melville Penn, M.D., PHD

Primary specialty

Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X

License

35027499 Issued in OH

Practice address

650 Shawan Falls Dr
Dublin, OH 43017-2100

Phone

(614) 764-1711

Fax

(614) 889-2652

NPI assigned

Dec 13, 2005

Last updated

Mar 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affiliated Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Dublin, OH
  • NPI 1982696894
  NPD
• Licking Memorial Professional Corporation

  dba Licking Memorial Pathologists

  • Anatomic Pathology & Clinical Pathology Physician
  • Newark, OH
  • NPI 1932186053
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206403200000",
    "number": "1073598132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 SHAWAN FALLS DR",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430172100",
            "telephone_number": "614-764-1711",
            "fax_number": "614-889-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 SHAWAN FALLS DR",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430172100",
            "telephone_number": "614-764-1711",
            "fax_number": "614-889-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "GERALD",
        "middle_name": "MELVILLE",
        "credential": "M.D., PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2008-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "OH",
            "license": "35027499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GRP ID",
            "identifier": "1351",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J'Autiana Peebles
• Elizabeth Peer
• John David Pelfrey, M.D.
• Courtney Pellack
• Kim Penfound
• Sarah Pennebaker, PA-C
• Anita Pennington
• Karen Penny
• Tannah Laine Penny, NURSE AIDE
• Anthony Penrose

• Dermatopathology (Pathology) Physician in Dublin, OH
• Providers in Dublin, OH by specialty
• Dermatopathology (Pathology) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.