Provider Demographics
NPI:1588663561
Name:PECK, ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:PECK
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 1:2925 VERNON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2425
Mailing Address - Country:US
Mailing Address - Phone:513-794-5600
Mailing Address - Fax:513-587-0470
Practice Address - Street 1:8231 CORNELL RD STE 320
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2281
Practice Address - Country:US
Practice Address - Phone:513-794-5600
Practice Address - Fax:513-587-0470
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064627207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0920516Medicaid
IN100008167OtherRAILROAD MEDICARE
IN200087380Medicaid
OH100008131OtherRAILROAD MEDICARE
OH0738732Medicare PIN
IN172430EMedicare PIN
IN200087380Medicaid