Divita, Penny S
Divita, Penny S is an individual health care provider with primary practice located at 830 Pennsylvania Ave Ste 200, Charleston WV 25302-3302. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Divita, Penny S can be contacted via phone (304) 388-2709.Contact Information
Primary practice address
830 Pennsylvania Ave Ste 200
Charleston WV 25302-3302
Phone: (304) 388-2709
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 1461 | West Virginia |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 1451 | West Virginia |
Profile Details
| NPI number | 1598744757 |
|---|---|
| LBN Legal business name | Divita, Penny S |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 16th, 2006 |
| Last updated | Jun 23rd, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598744757 | NPPES |
| West Virginia | Other | 001718046 | BLUE CROSS BLUE SHIELD |
| West Virginia | MEDICAID | 0046618000 | BLUE CROSS BLUE SHIELD |
| West Virginia | Other | 1040493 | BLUE CROSS BLUE SHIELD |
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