Provider Demographics
NPI:1003859331
Name:PEACOCK BIRSETT, JAMA LORYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMA
Middle Name:LORYNN
Last Name:PEACOCK BIRSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12833-0159
Mailing Address - Country:US
Mailing Address - Phone:518-450-9180
Mailing Address - Fax:518-886-1690
Practice Address - Street 1:68 WEST AVE STE 3
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6044
Practice Address - Country:US
Practice Address - Phone:518-450-9180
Practice Address - Fax:518-886-1690
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY239931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239931OtherNYC LICENSE
NYBP9770303OtherDEA
NYJ00001862Medicare PIN
NYBP9770303OtherDEA