Individual
MRS. PENELOPE MASHBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
27 ST. LAWRENCE DR., SUITE203, TIFFIN, OH 44883
(305) 575-9978
(419) 455-8564
Mailing address
2200 JEFFERSON AVE, 4TH FLOOR, TOLEDO, OH 43604-7101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34.011231
OH
390200000X
Student in an Organized Health Care Education/Training Program
P12-00612
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106134
—
OH
01
—
34011231
OHIO MEDICAL LICENSE
OH
Enumeration date
12/21/2009
Last updated
09/29/2014
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