Provider Demographics
NPI:1699761296
Name:PENIRD, KAREN SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUSAN
Last Name:PENIRD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4998 SHORTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9739
Mailing Address - Country:US
Mailing Address - Phone:585-289-8159
Mailing Address - Fax:
Practice Address - Street 1:500 HELENDALE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3173
Practice Address - Country:US
Practice Address - Phone:585-473-7028
Practice Address - Fax:585-473-0051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY206615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01805518Medicaid