Provider Demographics
NPI:1043669955
Name:PECK, ELANA (MD)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E PUTNAM AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1360
Mailing Address - Country:US
Mailing Address - Phone:203-637-3337
Mailing Address - Fax:203-637-3307
Practice Address - Street 1:1455 E PUTNAM AVE STE 1
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1360
Practice Address - Country:US
Practice Address - Phone:203-637-3337
Practice Address - Fax:203-637-3307
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT65356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program