Provider Demographics
NPI:1417940867
Name:PECKHAM, ROBYN H (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:H
Last Name:PECKHAM
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:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1060
Mailing Address - Country:US
Mailing Address - Phone:828-684-8201
Mailing Address - Fax:828-684-8601
Practice Address - Street 1:29 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732
Practice Address - Country:US
Practice Address - Phone:828-684-8201
Practice Address - Fax:828-684-8601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC980660NC207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891154KMedicaid
NC1154KOtherBCBS
D3689OtherMEDCOST
6658952OtherCIGNA
D3689OtherMEDCOST
G45815Medicare UPIN