Provider Demographics
NPI:1598407355
Name:PENNINGTON, THOMAS WAYNE (PRSS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WAYNE
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1810
Mailing Address - Country:US
Mailing Address - Phone:681-378-3908
Mailing Address - Fax:304-759-8836
Practice Address - Street 1:1123 S DAVIS AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3529
Practice Address - Country:US
Practice Address - Phone:681-378-3908
Practice Address - Fax:304-759-8836
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist