Provider Demographics
NPI:1043264104
Name:PEELLE, KENNETH R (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:PEELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3026
Mailing Address - Country:US
Mailing Address - Phone:978-685-8181
Mailing Address - Fax:978-688-2425
Practice Address - Street 1:185 GREAT POND RD
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-3026
Practice Address - Country:US
Practice Address - Phone:978-685-8181
Practice Address - Fax:978-688-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0376342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2030462Medicaid
MA2030462Medicaid
MAC05083Medicare ID - Type Unspecified