MEDICARE: PETER PEACOCK MD

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
1	207P00000X	Emergency Medicine Physician	213994-1	NY

General Provider Information

NPI Number	:	1821083098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER PEACOCK MD

Provider Business Mailing Address
First Line	:	451 CLARKSON AVE
Second Line	:	MEDICAL DIRECTOR'S OFFICE - B-1147
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2054
Country	:	US
Telephone Number	:	718-245-3921
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 CLARKSON AVE
Second Line	:	MEDICAL DIRECTOR'S OFFICE - B-1147
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2054
Country	:	US
Telephone Number	:	718-245-3921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/06/2015

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