Pennebaker, Richard Siddall

Pennebaker, Richard Siddall is an individual health care provider with primary practice located at 57 Cross Park Court , Greenville SC 29605-4264. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Pennebaker, Richard Siddall can be contacted via phone (864) 797-6044.

Contact Information

Primary practice address
57 Cross Park Court Greenville SC 29605-4264
Phone: (864) 797-6044
Fax: (864) 797-6198
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 12799 South Carolina

Profile Details

NPI number 1356399604
LBN Legal business name Pennebaker, Richard Siddall
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2006
Last updated Sep 14th, 2011 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356399604 NPPES
South Carolina MEDICAID TL5018

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