Provider Demographics
NPI:1922115013
Name:PENA, THELMA MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:MERCEDES
Last Name:PENA
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:PO BOX 534
Mailing Address - Street 2:1 SPEIR DRIVE
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0534
Mailing Address - Country:US
Mailing Address - Phone:973-762-0053
Mailing Address - Fax:
Practice Address - Street 1:340 W HANOVER AVE
Practice Address - Street 2:MORRISTOWN CBOC VA CLINIC
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-2777
Practice Address - Country:US
Practice Address - Phone:973-539-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04170200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine