Healthcare Provider Details

I. General information

NPI: 1356769772
Provider Name (Legal Business Name): MATTHEW SEAN PEACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 01/29/2024
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 STONE CREEK DR
GREENVILLE NC
27858-7191
US

IV. Provider business mailing address

1180 STONE CREEK DR
GREENVILLE NC
27858-7191
US

V. Phone/Fax

Practice location:
  • Phone: 434-249-8001
  • Fax:
Mailing address:
  • Phone: 434-249-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2019-01563
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: