Healthcare Provider Details

I. General information

NPI: 1598008484
Provider Name (Legal Business Name): PENN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESTATE THOMAS UNIT NO C-2 LOCKHART GARDENS
ST THOMAS VI
00802
US

IV. Provider business mailing address

6501 RED HOOK PLZ SUITE 201
ST THOMAS VI
00802-1305
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-5437
  • Fax:
Mailing address:
  • Phone: 340-774-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberVI 1425
License Number StateVI

VIII. Authorized Official

Name: DR. CECILIA NAA-SAKLE PENN
Title or Position: MEDICAL DIRECTOR
Credential: MD, MPH, FAAP
Phone: 340-513-2888