Provider Demographics
NPI:1154389559
Name:PENNOCK, JOHN LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:PENNOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:717-975-0900
Mailing Address - Fax:717-975-2724
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-975-0900
Practice Address - Fax:717-975-2724
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD014586E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35148Medicare UPIN