EDWARD BENJAMIN PENN JR. (NPI# 1053474163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053474163 |
| Entity Type | Individual |
| Full Name | EDWARD BENJAMIN PENN JR. |
| Credential | MD |
| Practice Address |
200 Patewood Dr Ste B400 Greenville SC 29615-6306 |
| Mailing Address |
1 Independence Pt Ste 212 Greenville SC 29615-4536 |
| Practice Telephone | 8644544368 |
| Practice Fax Number | 8642419232 |
| Mailing Telephone | 8647976303 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
51723 | SC | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 325 Medical Pkwy Ste 250, Greer, SC 296502460 | 8647979080 | 8647979085 |
| Street Address |
200 PATEWOOD DR STE B400 |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29615-6306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457905010 | Emily Herndon | Nurse Practitioner | 200 Patewood Dr Ste B400, Greenville, SC 29615-6306 | 2019-07-31 |
| 1518467430 | Anne Keating Norris | Nurse Practitioner | 200 Patewood Dr Ste B400, Greenville, SC 29615-6306 | 2018-02-16 |
| 1912410507 | Emily Anne Manny | Speech-Language Pathologist | 200 Patewood Dr Ste B400, Greenville, SC 29615-6306 | 2017-11-06 |
| 1336502590 | Mary Knight Felt | Physician Assistant | 200 Patewood Dr Ste B400, Greenville, SC 29615-6306 | 2016-04-04 |
| 1477840924 | Heather L Strader | Audiologist | 200 Patewood Dr Ste B400, Greenville, SC 29615-6306 | 2011-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358051 | Adenike Orogade | Behavior Technician | 17 Caldedon Ct, Suite B, Greenville, SC 29615 | 2020-02-19 |
| 1629608369 | Jennifer Jacobsen | Behavior Technician | 17 Caldedon Court, Suite B, Greenville, SC 29615 | 2020-01-22 |
| 1932668217 | Carolina Orthopaedic and Neurosurgical Associates | Orthopaedic Surgery | Carolina Orthopaedic and Neurosurgical Associates, 220 Roper Mountain Road Extension, Greenville, SC 29615 | 2019-03-18 |
| 1255816070 | Trevis L Cureton | Pharmacist | 2401 East North St, Greenville, SC 29615 | 2018-09-27 |
| 1497232565 | Jacob J Fountain | Nurse Practitioner | 225 Enterprise Blvd, Suite 101, Greenville, SC 29615 | 2018-07-23 |
| 1346726924 | St. Francis Physician Services, Inc | Internal Medicine | 5 Hoke Smith Blvd, Greenville, SC 29615 | 2018-07-17 |
| 1558853101 | Alexandra Michelle Taylor | Audiologist | 200 Patewood Dr Ste 400, Greenville, SC 29615 | 2018-05-30 |
| 1316466543 | Mariah Hope Mosher | Behavioral Analyst | 7 Mckenna Commons Court, Greenvilee, SC 29615 | 2017-09-19 |
| 1326400896 | Karen L Heaps | Counselor | 3150 S. Hwy 14, The Pelham Center, Greenville, SC 29615 | 2016-03-24 |
| 1134589013 | Sharon Erk | Technician, Other | 2950 E.norths St, Greenville, OH 29615 | 2016-03-04 |
| Find all providers in zip 29615 | ||||
| Taxonomy Code | 207YP0228X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Pediatric Otolaryngology |
| A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609491737 | Starfish Pediatric Ent, LLC | Otolaryngology | 110b Springhall Dr, Goose Creek, SC 29445-5335 | 2020-06-15 |
| 1396189486 | Phayvanh Pecha | Otolaryngology | 171 Ashley Ave, Charleston, SC 29425 | 2013-04-19 |
| 1962638502 | Clarice Seifert Clemmens | Otolaryngology | 171 Ashley Ave, Charleston, SC 29425-8908 | 2009-06-10 |
| 1134153083 | South Carolina Ent Allergy & Sleep Medicine Pa | Otolaryngology | 15 Exchange Dr, Lugoff, SC 29078-9198 | 2006-07-10 |
| 1447293121 | David Macy Vidrine | Otolaryngology | 15 Exchange Dr, Lugoff, SC 29078-9198 | 2006-06-13 |
| City | GREENVILLE |
| Zip Code | 29615 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.