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General NPI Number Information
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NPI Number | 1962053538
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Entity Type | Individual
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Provider Name | ROBERT DAVID PENN JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 323 FLEET ST
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City | NEW BERN
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State | NC
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Zip | 28562-5656
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Country | US
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Telephone | 252-470-6825
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Fax |
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Provider Business Mailing Address
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Address Line | 170 HEATH SWAMP RD
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City | COVE CITY
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State | NC
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Zip | 28523-9724
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Country | US
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Telephone | 319-213-2976
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-09297
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License Number State | NC
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