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NPI Code Detail

MEDICARE: DR. MICHAEL L. PECK D.O.

MEDICARE: DR. MICHAEL L. PECK D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) PhysicianXP1503172PA
2207Q00000XFamily Medicine PhysicianOS006590LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265427306
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL L. PECK D.O.
Provider Business Mailing Address
First Line : 3130 GRANDVIEW RD
Second Line :
City : HANOVER
State : PA
Zip : 17331-9134
Country : US
Telephone Number : 717-632-2088
Fax Number : 717-637-9482
Provider Business Practice Location Address
First Line : 2901 JOLLY RD
Second Line :
City : PLYMOUTH MEETING
State : PA
Zip : 19462-2324
Country : US
Telephone Number : 717-451-5956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 10/17/2024

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