Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 0101248195 | VA |
NPI | 1497845895 |
---|---|
Provider Name | Dr. Melinda Marie Christie Penn |
First Address | Norfolk, VA 23507-1910 |
Second Address | Norfolk, VA 23507-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 08/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101248195 | VIRGINIA MEDICAL LICENSE (01) | VA |