Provider Demographics
NPI:1598008484
Name:PENN PEDIATRICS
Entity type:Organization
Organization Name:PENN PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:NAA-SAKLE
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, FAAP
Authorized Official - Phone:340-513-2888
Mailing Address - Street 1:6501 RED HOOK PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1305
Mailing Address - Country:US
Mailing Address - Phone:340-774-5437
Mailing Address - Fax:
Practice Address - Street 1:1 ESTATE THOMAS UNIT NO C-2
Practice Address - Street 2:LOCKHART GARDENS
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIVI 1425261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care