Healthcare Provider Details

I. General information

NPI: 1932102647
Provider Name (Legal Business Name): JOSEPH C PENNINGTON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST STE 533A
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

PO BOX 824804
PHILADELPHIA PA
19182-4804
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-4828
  • Fax: 302-421-6971
Mailing address:
  • Phone: 302-421-4828
  • Fax: 302-421-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC10004298
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: