Active NPI
Andrea R Penepacker, M.D.
- Pediatrics Physician
- Dover, OH
National Provider Identifier
1467538892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35-082468
- Practice address
- 204 S Bellevue Ave
Dover, OH 44622-9405 - Phone
- (330) 343-3321
- Fax
- (330) 602-8712
- NPI assigned
- Oct 27, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35-082468 | OH | Primary |
Addresses
Primary practice location
204 S Bellevue Ave
Dover, OH 44622-9405
Mailing address
204 S Bellevue Ave
Dover, OH 44622-9405
Phone (330) 343-3321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2437456 | 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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35-082468 | OH | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467538892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 S BELLEVUE AVE",
"city": "DOVER",
"state": "OH",
"postal_code": "446229405",
"telephone_number": "330-343-3321",
"fax_number": "330-602-8712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 S BELLEVUE AVE",
"city": "DOVER",
"state": "OH",
"postal_code": "446229405",
"telephone_number": "330-343-3321",
"fax_number": "330-602-8712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENEPACKER",
"first_name": "ANDREA",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35-082468",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2437456",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dover, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.