Individual
DR. GREGORY L. PENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
331 MAINE ST STE 4, BRUNSWICK, ME 04011-3359
(207) 721-0911
(207) 721-9729
Mailing address
331 MAINE ST, SUITE 4, BRUNSWICK, ME 04011-3358
(207) 721-0911
(207) 721-9729
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12949
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017636
BS
ME
01
—
1027557
AETNA
ME
05
—
122050000
—
ME
Enumeration date
11/01/2006
Last updated
06/22/2015
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