Provider Demographics
NPI:1467535807
Name:PENNINGTON, DON LAVAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:LAVAR
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1527
Mailing Address - Country:US
Mailing Address - Phone:803-541-8880
Mailing Address - Fax:803-541-8885
Practice Address - Street 1:154 WREN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1527
Practice Address - Country:US
Practice Address - Phone:803-541-8880
Practice Address - Fax:803-541-8885
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD74180Medicare UPIN