Basic Information
Provider Information
NPI: 1174979298
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PENNAROLA
FirstName: ADAM
MiddleName: FRANCIS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1015 WALNUT ST STE 401
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191075005
CountryCode: US
TelephoneNumber: 2159552363
FaxNumber: 2159552516
Practice Location
Address1: 833 CHESTNUT ST STE 220
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191074405
CountryCode: US
TelephoneNumber: 2159552363
FaxNumber: 2159552516
Other Information
ProviderEnumerationDate: 05/07/2016
LastUpdateDate: 07/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0002XMD469533PAY Allopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine

No ID Information.


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