Individual
CHARLES G PENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 SAM PERRY BLVD, FREDERICKSBURG, VA 22401
(540) 741-1167
Mailing address
PO BOX 888, FREDERICKSBURG, VA 22404
(800) 888-1752
(616) 975-9824
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
0101034485
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00130695
RAILROAD MEDICARE
—
Enumeration date
06/09/2006
Last updated
11/20/2007
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