Provider Demographics
NPI:1588643233
Name:PECK, SUSAN D (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:PECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3709
Mailing Address - Country:US
Mailing Address - Phone:717-316-2255
Mailing Address - Fax:
Practice Address - Street 1:300 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3709
Practice Address - Country:US
Practice Address - Phone:717-316-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004392L207V00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01808201OtherCAPITAL BC / KEYSTONE
PA1519553OtherGATEWAY
PAPE427802OtherPA BLUE SHIELD
PA097088207Medicaid
PAPE427802OtherPA BLUE SHIELD