Healthcare Provider Details

I. General information

NPI: 1972524361
Provider Name (Legal Business Name): JASON A PECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8037 CORPORATE CENTER DRIVE SUITE 400
CHARLOTTE NC
28226-4550
US

IV. Provider business mailing address

8037 CORPORATE CENTER DRIVE SUITE 400
CHARLOTTE NC
28226-4550
US

V. Phone/Fax

Practice location:
  • Phone: 704-659-1052
  • Fax: 888-869-6879
Mailing address:
  • Phone: 704-659-1052
  • Fax: 888-869-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2003-00865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: