Provider Demographics
NPI:1316936131
Name:PENNINGS, SIMON P (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:P
Last Name:PENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CAMPUS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9703
Mailing Address - Country:US
Mailing Address - Phone:276-628-1186
Mailing Address - Fax:276-628-8507
Practice Address - Street 1:613 CAMPUS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9703
Practice Address - Country:US
Practice Address - Phone:276-628-1186
Practice Address - Fax:276-628-8507
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034401207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4583916OtherAETNA
02OtherJD
VA5642507Medicaid
VA1316936131Medicaid
064411OtherANTHEM
3054602OtherBLUE CLASSIC
43304OtherOPTIMA SENTARA
B07663Medicare UPIN
VA5642507Medicaid
3054602OtherBLUE CLASSIC