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General NPI Number Information
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NPI Number | 1821061276
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Entity Type | Individual
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Provider Name | MIMI I PEAK M.D, M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 515 STERNBERG AVE MACDONALD ARMY COMMUNITY HOSPITAL
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City | FORT EUSTIS
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State | VA
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Zip | 23604-1526
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Country | US
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Telephone | 757-314-7613
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Fax |
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Provider Business Mailing Address
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Address Line | 30 MILFORD RD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-3938
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Country | US
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Telephone |
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Fax |
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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 | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 0101055670
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 0101055670
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License Number State | VA
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