Provider Demographics
NPI:1295728251
Name:PENNINGTON, NORMAN E (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:E
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-382-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00695352085R0202X
PAMD4300242085R0202X
NJ25MA088901002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304914OtherBCMH
OH000000516222OtherANTHEM
OH0681203Medicaid
OHP00417123OtherRAILROAD MEDICARE
OH000000221292OtherUNISON
OH363907OtherWELLCARE
OH4317533OtherAETNA
OHP00412516OtherRAILROAD MEDIVARE
CK1297OtherRAILROAD MEDICARE
OH0681203Medicaid
OHP00417123OtherRAILROAD MEDICARE
OHPE4159827Medicare PIN