Paul Pennza, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35042484P Issued in OH

Practice address

822 Kumho Dr
Suite 202
Fairlawn, OH 44333-9297

Phone

(330) 576-0500

Fax

(330) 576-0467

NPI assigned

Jun 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239062400000",
    "number": "1518993575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 KUMHO DR",
            "address_2": "SUITE 202",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339297",
            "telephone_number": "330-576-0500",
            "fax_number": "330-576-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 KUMHO DR",
            "address_2": "SUITE 202",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339297",
            "telephone_number": "330-576-0500",
            "fax_number": "330-576-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNZA",
        "first_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2009-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35042484P",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35042484",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000141923",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0423616",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007548749",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Michael Pelini, PA-C
• Brandon Pendleton
• Dwynica S Pendleton
• Joshua Penman
• Katherine Pennington
• Megan P Perkins, M.A.,CCC-SLP
• Jennifer L Petersen, PA-C
• Karen Angela Petit, PHYSICAL THERAPIST
• Rachel Ann Petrella, PT, DPT
• Morgan Petroff, OTR

• Family Medicine Physician in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.