Basic Information
| Provider Information | |||||||||
| NPI: | 1205929213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENSY | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 KERNAN DR | ||||||||
| Address2: | SUITE 1154 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212076665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104486400 | ||||||||
| FaxNumber: | 4104486296 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 KERNAN DR | ||||||||
| Address2: | SUITE 1154 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212076665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104486400 | ||||||||
| FaxNumber: | 4104486296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | D0062198 | MD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | D0062198 | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 411592900 | 05 | MD | MEDICAID | 1205929213 | 01 | MD | NPI | OTHER | 3810008225 | 05 | WV | MEDICAID | D0062198 | 01 | MD | MD LICENSE | OTHER |