Provider Demographics
NPI:1588602262
Name:BYCK, PEGGY L (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:BYCK
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 1:6602 WATERS AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2778
Mailing Address - Country:US
Mailing Address - Phone:912-350-6000
Mailing Address - Fax:912-350-6001
Practice Address - Street 1:6602 WATERS AVE BLDG A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2778
Practice Address - Country:US
Practice Address - Phone:912-350-6000
Practice Address - Fax:912-350-6001
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349731OtherWELLCARE
SCG32880Medicaid
GA52506457-003OtherBCBS GA
GA000439612DMedicaid
GA52506457-001OtherBCBS GA
GA000439612EMedicaid
GA000439612FMedicaid
GA10063559OtherAMERIGROUP
4598872OtherAETNA
GAP00290731OtherRR MEDICARE ID
GA000439612EMedicaid
GAP00290731OtherRR MEDICARE ID