Provider Demographics
NPI:1114027950
Name:PECK, CAROLINE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ANNE
Last Name:PECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 997413
Mailing Address - Street 2:MS 7213
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95899-7413
Mailing Address - Country:US
Mailing Address - Phone:916-552-9940
Mailing Address - Fax:916-552-9994
Practice Address - Street 1:1616 CAPITOL AVE
Practice Address - Street 2:STE 74.3.84
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5052
Practice Address - Country:US
Practice Address - Phone:916-552-9940
Practice Address - Fax:916-552-9994
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA056319207V00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01789813Medicaid
AZ486896Medicaid
CO65924843Medicaid
NM01789813Medicaid
NM84220CMedicare ID - Type UnspecifiedDZ
CO65924843Medicaid