MEDICARE: MR. DAVID L PENDLETON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0348	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0348	OTHER	NH	STATE LICENCE NUMBER

General Provider Information

NPI Number	:	1346281169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID L PENDLETON PA-C

Provider Business Mailing Address
First Line	:	9 TUTTLE RD
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-4328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 S MAIN ST
Second Line	:	SUITE 300
City	:	MANCHESTER
State	:	NH
Zip	:	03102-5166
Country	:	US
Telephone Number	:	603-625-6198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	10/29/2020

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