Provider Demographics
NPI:1255420667
Name:PENBERTHY, KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PENBERTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:430 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030
Practice Address - Country:US
Practice Address - Phone:856-456-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA077687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ42477OtherUNIVERSITY HEALTH PLAN
NJP00278714OtherRR MEDICARE
NJ3K6217OtherHEALTHNET, INC
NJ1764618OtherAMERIHEALTH PPO/PABS
NJ8397292OtherCIGNA
NJ60018543OtherHORIZON NJ HEALTH
NJ0070106Medicaid
NJ010007469OtherAMERICHOICE
NJ2430550000OtherAMERIHEALTH/KEYSTONE/IBC
NJ2566179OtherUNITED HEALTHCARE
NJ3949355OtherAETNA
NJP3658002OtherOXFORD
NJ135766Medicare UPIN
NJ0070106Medicaid