Healthcare Provider Details

I. General information

NPI: 1386652162
Provider Name (Legal Business Name): LILIAN R PEAKE M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GOVERNOR ST
RICHMOND VA
23219
US

IV. Provider business mailing address

109 GOVERNOR ST
RICHMOND VA
23219
US

V. Phone/Fax

Practice location:
  • Phone: 434-972-6226
  • Fax: 434-972-4310
Mailing address:
  • Phone: 804-864-7651
  • Fax: 434-972-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101230309
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: