Healthcare Provider Details

I. General information

NPI: 1437280807
Provider Name (Legal Business Name): MICHAEL GLENN PENNY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/13/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER PORTSMOUTH 620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708
US

V. Phone/Fax

Practice location:
  • Phone: 757-462-4316
  • Fax:
Mailing address:
  • Phone: 757-953-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA55439
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA55439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: