Provider Demographics
NPI:1508083759
Name:PENNINGTON, ROSHNEE K (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSHNEE
Middle Name:K
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 SHADY GROVE RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6352
Mailing Address - Country:US
Mailing Address - Phone:301-251-9555
Mailing Address - Fax:301-309-0765
Practice Address - Street 1:15001 SHADY GROVE RD
Practice Address - Street 2:SUITE #110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6352
Practice Address - Country:US
Practice Address - Phone:301-251-9555
Practice Address - Fax:301-309-0765
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC02383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant