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Individual

TIMOTHY PAUL PENDLETON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
111 SUMMIT STREET, BROOKVILLE, PA 15825
(814) 849-8329
(814) 849-5441
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 849-8329
(814) 849-5441

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
A53094
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD428157
PA
207RP1001X
Pulmonary Disease Physician
Primary
MD428157
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101770225
PA
01
104242
GEISINGER
PA
01
1486953
AETNA
PA
01
612414900
BLACK LUNG
PA
Enumeration date
02/23/2006
Last updated
12/16/2014
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