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Individual

ANDREA R PENEPACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
204 S BELLEVUE AVE, DOVER, OH 44622-9405
(330) 343-3321
(330) 602-8712
Mailing address
204 S BELLEVUE AVE, DOVER, OH 44622-9405
(330) 343-3321
(330) 602-8712

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35-082468
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2437456
OH
Enumeration date
10/27/2006
Last updated
07/08/2007
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