Individual
PENNY S DIVITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1461
WV
208000000X
Pediatrics Physician
Primary
1451
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001718046
BLUE CROSS BLUE SHIELD
WV
05
—
0046618000
—
WV
01
—
1040493
DWC
WV
Enumeration date
01/16/2006
Last updated
06/23/2011
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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