Individual
KEVIN MICHAEL PENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-0001
(570) 271-6211
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061829
PA
Other
Enumeration date
09/02/2020
Last updated
10/14/2020
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