Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS006590L | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | XP1503172 | PA |
NPI | 1265427306 |
---|---|
Provider Name | Dr. Michael L. Peck |
First Address | Hanover, PA 17331-9134 |
Second Address | Hanover, PA 17331-9134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 30/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001133191 | (05) | PA |
C33857 | (02) |