Healthcare Provider Details

I. General information

NPI: 1154395945
Provider Name (Legal Business Name): ROBERT A PENNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 PINE ST
BURLINGTON VT
05401-4933
US

IV. Provider business mailing address

600 BLAIR PARK RD SUITE 190
WILLISTON VT
05495-7586
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-0693
  • Fax: 802-860-6613
Mailing address:
  • Phone: 802-872-4343
  • Fax: 802-872-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0007370
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: