Provider Demographics
NPI:1487251971
Name:PENTEK, MARGARET A
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:A
Last Name:PENTEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 COUNTY ROAD 128
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8526
Mailing Address - Country:US
Mailing Address - Phone:174-053-4235
Mailing Address - Fax:
Practice Address - Street 1:1375 COUNTY ROAD 128
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-8526
Practice Address - Country:US
Practice Address - Phone:174-053-4235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2957224163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH443033148001Medicaid