Organization Name: | MICHAEL L. PECK, D.O., LLC |
NPI Number: | 1003878786 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL L. PECK (PHYSICIAN/OWNER) |
Mailing Address: | 3130 Grandview Rd Hanover |
State: | PA US |
Postal Code: | 173319134 |
Phone Number: | 7176370839 |
Fax Number: | 7176379314 |
NPI Enumeration Date: | 04/06/2006 |
NPI Last Update Date: | 12/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |