Provider Demographics
NPI:1326000266
Name:PENNINGTON, DEMETRIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIA
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 STATE ROUTE 27
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3980
Mailing Address - Country:US
Mailing Address - Phone:732-828-4850
Mailing Address - Fax:732-828-4290
Practice Address - Street 1:1553 STATE ROUTE 27
Practice Address - Street 2:SUITE 1800
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3980
Practice Address - Country:US
Practice Address - Phone:732-828-4850
Practice Address - Fax:732-828-4290
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA6646600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics