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NPI Code Detail

MEDICARE: PETER PEACOCK MD

MEDICARE: PETER PEACOCK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician213994-1NY

General Provider Information

NPI Number : 1821083098
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER PEACOCK MD
Provider Business Mailing Address
First Line : 451 CLARKSON AVE
Second Line : MEDICAL DIRECTOR'S OFFICE - B-1147
City : BROOKLYN
State : NY
Zip : 11203-2054
Country : US
Telephone Number : 718-245-3921
Fax Number :
Provider Business Practice Location Address
First Line : 451 CLARKSON AVE
Second Line : MEDICAL DIRECTOR'S OFFICE - B-1147
City : BROOKLYN
State : NY
Zip : 11203-2054
Country : US
Telephone Number : 718-245-3921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 04/06/2015

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