Healthcare Provider Details

I. General information

NPI: 1730155748
Provider Name (Legal Business Name): PAUL C PENNOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST SUITE 407
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

252 CHAPMAN RD SUITE 150
NEWARK DE
19702-5436
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-9721
  • Fax: 302-421-9728
Mailing address:
  • Phone: 302-366-1929
  • Fax: 302-366-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC10000416
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: