Provider Demographics
NPI:1013113083
Name:ROBERT C. PENNINGTON, MD, PC
Entity Type:Organization
Organization Name:ROBERT C. PENNINGTON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-425-2297
Mailing Address - Street 1:311 COURTHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2421
Mailing Address - Country:US
Mailing Address - Phone:304-487-2297
Mailing Address - Fax:304-487-4802
Practice Address - Street 1:311 COURTHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-487-2297
Practice Address - Fax:304-487-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25068207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562129755OtherTAX IDENTIFIER
86314OtherMEDCOST
WV3810024625Medicaid
NC89-1070VMedicaid
NC562129755OtherTAX IDENTIFIER
2247126AMedicare PIN
86314OtherMEDCOST
WV=========OtherTAX IDENTIFIER
NC562129755OtherTAX IDENTIFIER