Provider Demographics
NPI:1437574472
Name:PECK, COLLEEN (CNM)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 QUEBEC ST NW APT 516
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1269
Mailing Address - Country:US
Mailing Address - Phone:410-236-2417
Mailing Address - Fax:
Practice Address - Street 1:1225 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3431
Practice Address - Country:US
Practice Address - Phone:202-347-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001597176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03924807Medicaid