Provider Demographics
NPI:1356098495
Name:PECHENENKO, ANITA V (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:V
Last Name:PECHENENKO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3551 ROGER BROOKE DR., SAN ANTONIO MILITARY MEDICAL CTR
Mailing Address - Street 2:MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-292-7805
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:3551 ROGER BROOKE DR., SAN ANTONIO MILITARY MEDICAL CTR
Practice Address - Street 2:MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
Practice Address - City:JBSA-FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-292-7805
Practice Address - Fax:210-292-7868
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2023-11-30
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Provider Licenses
StateLicense IDTaxonomies
VA0101279932208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice