Healthcare Provider Details

I. General information

NPI: 1366437717
Provider Name (Legal Business Name): MARK ANDREW PECKMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TOWN CENTER AVE STE 301
COLUMBIANA OH
44408-8312
US

IV. Provider business mailing address

400 TOWN CENTER AVE STE 301
COLUMBIANA OH
44408-8312
US

V. Phone/Fax

Practice location:
  • Phone: 330-482-3762
  • Fax: 330-482-3840
Mailing address:
  • Phone: 330-482-3762
  • Fax: 330-482-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34005181P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: