Individual
GARY PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11910 PARKSIDE DR, FAIRFAX, VA 22033-2648
(202) 816-2832
Mailing address
11910 PARKSIDE DR, FAIRFAX, VA 22033-2648
(202) 816-2832
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101027481
VA
207Q00000X
Family Medicine Physician
12875
NE
Other
Enumeration date
11/27/2006
Last updated
03/08/2022
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