Basic Information
| Provider Information | |||||||||
| NPI: | 1720441207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENNINGTON | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | MASON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WHITE STREET | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104496500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 FORRESTAL DR BLDG 33 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235510001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579533647 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101263036 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.