Healthcare Provider Details

I. General information

NPI: 1942420906
Provider Name (Legal Business Name): MARTHA G PECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA JEAN GABRIEL MD

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 LOUIS STEPHENS DR
MORRISVILLE NC
27560-6399
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 919-994-6331
  • Fax: 919-590-6777
Mailing address:
  • Phone: 919-994-6331
  • Fax: 919-590-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006-01719
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: