MEDICARE: HEATHER PENNY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C5-0000360	DE
2	363A00000X	Physician Assistant	C0002644	MD
3	363AM0700X	Medical Physician Assistant	MA003295L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427069392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER PENNY PA-C

Provider Business Mailing Address
First Line	:	900 W BALTIMORE PIKE
Second Line	:	SUITE4 200
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9313
Country	:	US
Telephone Number	:	610-869-4627
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W BALTIMORE PIKE
Second Line	:	SUITE4 200
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9313
Country	:	US
Telephone Number	:	610-869-4627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/05/2016

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Directions to “ HEATHER PENNY PA-C” Practice Location

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