Provider Demographics
NPI:1568628527
Name:MUCIUS-PENHA, BERNICE NATALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:NATALIE
Last Name:MUCIUS-PENHA
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 1:14024 WILEY CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5578
Mailing Address - Country:US
Mailing Address - Phone:516-673-8554
Mailing Address - Fax:804-818-2637
Practice Address - Street 1:14024 WILEY CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-5578
Practice Address - Country:US
Practice Address - Phone:516-673-8554
Practice Address - Fax:804-818-2637
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116020317207Q00000X
VA0101249977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568628527Medicare UPIN