Provider Demographics
NPI:1497791669
Name:PENNINGTON, TRACEY O (MD,MPH)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:O
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5320 PROVIDENCE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4122
Mailing Address - Country:US
Mailing Address - Phone:757-962-2121
Mailing Address - Fax:757-962-1911
Practice Address - Street 1:5320 PROVIDENCE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4122
Practice Address - Country:US
Practice Address - Phone:757-962-2121
Practice Address - Fax:757-962-1911
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012318492081S0010X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVH70222Medicare UPIN