MEDICARE: NICHOLAS J PENNINGS DO

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	207Q00000X	Family Medicine Physician	174478	NY
2	207Q00000X	Family Medicine Physician	1469	SC

General Provider Information

NPI Number	:	1982642096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS J PENNINGS DO

Provider Business Mailing Address
First Line	:	3816 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5069
Country	:	US
Telephone Number	:	843-272-1411
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5069
Country	:	US
Telephone Number	:	843-272-1411
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/26/2012

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