Provider Demographics
NPI:1982642096
Name:PENNINGS, NICHOLAS J (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:PENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5069
Mailing Address - Country:US
Mailing Address - Phone:843-272-1411
Mailing Address - Fax:
Practice Address - Street 1:3816 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-5069
Practice Address - Country:US
Practice Address - Phone:843-272-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174478207Q00000X
SC1469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E03545Medicare UPIN