Provider Demographics
NPI:1942287313
Name:PENN, MARCUS L (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:L
Last Name:PENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-571-9700
Mailing Address - Fax:410-571-9710
Practice Address - Street 1:2000 MEDICAL PKWY STE 306
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3745
Practice Address - Country:US
Practice Address - Phone:410-571-9700
Practice Address - Fax:410-571-9710
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0043531174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF40306Medicare UPIN