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General NPI Number Information
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NPI Number | 1265427306
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Entity Type | Individual
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Provider Name | MICHAEL L. PECK D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 2901 JOLLY RD
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-2324
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Country | US
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Telephone | 717-451-5956
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 GRANDVIEW RD
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City | HANOVER
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State | PA
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Zip | 17331-9134
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Country | US
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Telephone | 717-632-2088
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Fax | 717-637-9482
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | XP1503172
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS006590L
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License Number State | PA
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