MEDICARE: MR. ROBERT DAVID PENN JR. 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	0010-09297	NC

General Provider Information

NPI Number	:	1962053538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DAVID PENN JR. PA-C

Provider Business Mailing Address
First Line	:	170 HEATH SWAMP RD
Second Line	:
City	:	COVE CITY
State	:	NC
Zip	:	28523-9724
Country	:	US
Telephone Number	:	319-213-2976
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 FLEET ST
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5656
Country	:	US
Telephone Number	:	252-470-6825
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	02/11/2025

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