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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 15 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 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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