Individual provider Active NPI

Mary E Fontana-Penn, MD

  • Allergy Physician
  • Nottingham, MD
National Provider Identifier
1750367074
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
D0069408 Issued in MD
Practice address
7939 Honeygo Blvd
Suite 219
Nottingham, MD 21236-4931
Phone
(410) 931-0404
Fax
(410) 931-0405
NPI assigned
Dec 19, 2005
Last updated
Jan 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X D0069408 MD Primary

Addresses

Primary practice location

7939 Honeygo Blvd
Suite 219
Nottingham, MD 21236-4931

Mailing address

5430 Campbell Blvd Ste 103
White Marsh, MD 21162-5503
Phone (410) 933-9404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201116000143 PA Practitioner - Allergy/Immunology 6800932237 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0069408MDMDAllergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc Current Accepting new patients
Childen's Health Care Associates Inc. CurrentSince Mar 2, 2020 Accepting new patients
Childrens Health Care Associates, Inc CurrentSince Mar 2, 2020 Accepting new patients
Childrens Health Care Associates of New Jersey PC Past Accepting new patients
Allergy Asthma & Arthritis Associates P C PastSince Aug 1, 2016 Accepting new patients
Bucks-Mont Dermatology Associates PC Past Accepting new patients

Locations

481 John Young Way
Exton, PA 19341
Phone (610) 524-9885

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1750367074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 CAMPBELL BLVD STE 103",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "211625503",
            "telephone_number": "410-933-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7939 HONEYGO BLVD",
            "address_2": "SUITE 219",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212364931",
            "telephone_number": "410-931-0404",
            "fax_number": "410-931-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTANA-PENN",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-19",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "MD",
            "license": "D0069408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

Verify at the official NPI Registry.