Provider Demographics
NPI:1821039140
Name:PECK, BRADLEY KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KEVIN
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 1:4970 WYFFELS RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 PARRISH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-1960
Practice Address - Fax:585-393-9232
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185744207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01257721Medicaid
NY6911OtherEXCELLUS ROCHESTER
NY0500141OtherGHI
NY102665CUOtherPREFERRED CARE
NY01257721Medicaid
NY5406505OtherAETNA
NY912067001OtherHEALTHNOW
NY102665CUOtherPREFERRED CARE
NY01257721Medicaid