Active NPI
Lawrence Charles Penvose, DO
- Internal Medicine Physician
- Canton, OH
National Provider Identifier
1437269347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 34004573
- Practice address
- 1445 Harrison Avenue NW
Canton, OH 44708 - Phone
- (330) 455-4531
- Fax
- (330) 455-0119
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 34004573 | OH | Primary |
Addresses
Primary practice location
1445 Harrison Avenue NW
Canton, OH 44708
Mailing address
1445 Harrison Ave NW Ste 105
Canton, OH 44708-2634
Phone (330) 455-4531
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0821267 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34004573 | OH | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359504000000",
"number": "1437269347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1445 HARRISON AVE NW STE 105",
"city": "CANTON",
"state": "OH",
"postal_code": "447082634",
"telephone_number": "330-455-4531",
"fax_number": "330-455-0119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 HARRISON AVENUE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "44708",
"telephone_number": "330-455-4531",
"fax_number": "330-455-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENVOSE",
"first_name": "LAWRENCE",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2013-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "34004573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0821267",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.