MEDICARE: CAROL B PEDDICORD 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	207R00000X	Internal Medicine Physician	25961	KY
2	207Q00000X	Family Medicine Physician	25961	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1912990607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL B PEDDICORD MD

Provider Business Mailing Address
First Line	:	250 BURKESVILLE RD
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-1604
Country	:	US
Telephone Number	:	606-387-0323
Fax Number	:	606-387-0310

Provider Business Practice Location Address
First Line	:	250 BURKESVILLE RD
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-1604
Country	:	US
Telephone Number	:	606-387-0323
Fax Number	:	606-387-0310

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/01/2022

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