MEDICARE: JOSEPH C PENNINGTON III M.D.

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	207RC0001X	Clinical Cardiac Electrophysiology Physician	C10004298	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932102647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH C PENNINGTON III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 824804
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-4804
Country	:	US
Telephone Number	:	302-421-4828
Fax Number	:	302-421-6971

Provider Business Practice Location Address
First Line	:	701 N CLAYTON ST STE 533A
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-3165
Country	:	US
Telephone Number	:	302-421-4828
Fax Number	:	302-421-6971

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/18/2021

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