Provider Demographics
NPI:1366582959
Name:BREWSTER, PENNY JEAN (MD)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:JEAN
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:JEAN
Other - Last Name:HEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-0666
Mailing Address - Country:US
Mailing Address - Phone:828-497-1991
Mailing Address - Fax:
Practice Address - Street 1:806 ACQUONI RD.
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8TA059Medicare ID - Type Unspecified
I00355Medicare UPIN