Healthcare Provider Details

I. General information

NPI: 1386688877
Provider Name (Legal Business Name): COURTNEY PECK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GUEST ST STE 200
BRIGHTON MA
02135-2040
US

IV. Provider business mailing address

20 GUEST ST STE 200
BRIGHTON MA
02135-2040
US

V. Phone/Fax

Practice location:
  • Phone: 617-475-0496
  • Fax: 213-265-9954
Mailing address:
  • Phone: 617-475-0496
  • Fax: 213-265-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1126
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: