Provider Demographics
NPI:1669627493
Name:PETER B. VAN DYCK, MD & ASSOCIATES, PA
Entity Type:Organization
Organization Name:PETER B. VAN DYCK, MD & ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-1800
Mailing Address - Street 1:PO BOX 80155
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27623-0155
Mailing Address - Country:US
Mailing Address - Phone:919-781-1800
Mailing Address - Fax:919-781-1899
Practice Address - Street 1:4601 LAKE BOONE TRL STE 1B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-781-1800
Practice Address - Fax:919-781-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty