Provider Demographics
NPI:1689877300
Name:PENNINGTON, CARMAN D JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:CARMAN
Middle Name:D
Last Name:PENNINGTON
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 295
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9746
Mailing Address - Country:US
Mailing Address - Phone:304-637-1002
Mailing Address - Fax:304-636-3829
Practice Address - Street 1:RR 1 BOX 295
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9746
Practice Address - Country:US
Practice Address - Phone:304-637-1002
Practice Address - Fax:304-636-3829
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2003-1344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist