Provider Demographics
NPI:1760483002
Name:PECK, DIANE GRIFFITHS (CNM)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:GRIFFITHS
Last Name:PECK
Suffix:
Gender:F
Credentials:CNM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:415 COLUMBIA ROAD
Mailing Address - Street 2:UPHAMS CORNER HEALTH CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:617-740-8000
Mailing Address - Fax:617-740-8060
Practice Address - Street 1:415 COLUMBIA ROAD
Practice Address - Street 2:UPHAMS CORNER HEALTH CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:617-740-8000
Practice Address - Fax:617-740-8060
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MANM172899367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife