Individual
ADAM M PENFOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2373 W MAIN ST, STE 102, SALEM, WV 26426-7515
(304) 782-2000
(304) 782-3102
Mailing address
PO BOX 392, SALEM, WV 26426-0392
(304) 782-2000
(304) 782-3102
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2610
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2610
TEMPORARY STATE LICENSE
WV
Enumeration date
06/23/2014
Last updated
01/11/2021
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