Healthcare Provider Details

I. General information

NPI: 1346281169
Provider Name (Legal Business Name): DAVID L PENDLETON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 S MAIN ST SUITE 300
MANCHESTER NH
03102-5166
US

IV. Provider business mailing address

9 TUTTLE RD
BEDFORD NH
03110-4328
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-6198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0348
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: