Provider Demographics
NPI:1134478415
Name:PEAPER, JEFFREY MARK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MARK
Last Name:PEAPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1419 KNECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1415
Mailing Address - Country:US
Mailing Address - Phone:410-247-9595
Mailing Address - Fax:410-247-7553
Practice Address - Street 1:1419 KNECHT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1415
Practice Address - Country:US
Practice Address - Phone:410-247-9595
Practice Address - Fax:410-247-7553
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant