Provider Demographics
NPI:1639340458
Name:PECK, MEGAN MARIE
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:SCHUMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11241 ROAD F11
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9639
Mailing Address - Country:US
Mailing Address - Phone:419-231-5586
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-257-5639
Practice Address - Fax:614-257-5460
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant