MEDICARE: MS. TRACEY O PENNINGTON M.D.,M.P.H.

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	0101231849	VA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	0101231849	VA

General Provider Information

NPI Number	:	1497791669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEY O PENNINGTON M.D.,M.P.H.

Provider Business Mailing Address
First Line	:	5320 PROVIDENCE RD
Second Line	:	SUITE 204
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4122
Country	:	US
Telephone Number	:	757-962-2121
Fax Number	:	757-962-1911

Provider Business Practice Location Address
First Line	:	5320 PROVIDENCE RD
Second Line	:	SUITE 204
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4122
Country	:	US
Telephone Number	:	757-962-2121
Fax Number	:	757-962-1911

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/03/2016

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