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General NPI Number Information
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NPI Number | 1922115013
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Entity Type | Individual
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Provider Name | THELMA MERCEDES PENA MD
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 340 W HANOVER AVE MORRISTOWN CBOC VA CLINIC
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City | MORRISTOWN
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State | NJ
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Zip | 07960-2777
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Country | US
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Telephone | 973-539-9794
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 534 1 SPEIR DRIVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-0534
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Country | US
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Telephone | 973-762-0053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA04170200
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License Number State | NJ
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