Provider Demographics
NPI:1851393201
Name:DUVALL, PENELOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:
Last Name:DUVALL
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 1:4458 THORNCROFT DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3335
Mailing Address - Country:US
Mailing Address - Phone:215-272-7500
Mailing Address - Fax:
Practice Address - Street 1:2246 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3559
Practice Address - Country:US
Practice Address - Phone:804-642-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0794702084P0800X
VAPENDING2084N0400X
FLME925672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35413Medicare UPIN
FLU4697ZMedicare ID - Type Unspecified