Healthcare Provider Details

I. General information

NPI: 1073508362
Provider Name (Legal Business Name): LAUREN A PECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN A SHAW M.D.

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11258 LEBANON RD
CINCINNATI OH
45241-2214
US

IV. Provider business mailing address

4370 WOODLANDS PL
CINCINNATI OH
45241-2441
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-0044
  • Fax: 513-563-0061
Mailing address:
  • Phone: 513-563-0044
  • Fax: 513-563-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-06-4930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: