Individual
AMANDA MARIE PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1656 RIVERCHASE BLVD, ROCK HILL, SC 29732-1724
(803) 329-5131
(803) 366-6600
Mailing address
PO BOX 602120, CHARLOTTE, NC 28260-2120
(803) 329-5131
(803) 366-6600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20333
SC
207Q00000X
Family Medicine Physician
9300562
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080152242
RAILROAD MEDICARE
—
05
—
1144247099
—
NC
05
—
203336
—
SC
01
—
66763
BLUE CROSS BLUE SHIELD NC
NC
05
—
8966763
—
NC
Enumeration date
07/16/2006
Last updated
07/08/2014
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