Provider Demographics
NPI:1457462970
Name:PENCE, DAVID W
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:PENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KNOWLSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1634
Mailing Address - Country:US
Mailing Address - Phone:724-891-2100
Mailing Address - Fax:724-891-2734
Practice Address - Street 1:100 KNOWLSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1634
Practice Address - Country:US
Practice Address - Phone:724-891-2100
Practice Address - Fax:724-891-2734
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001997L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical