Provider Demographics
NPI:1851944920
Name:PECK, MARCIA ELAINE
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELAINE
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ASHFORD ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120
Mailing Address - Country:US
Mailing Address - Phone:860-216-5758
Mailing Address - Fax:
Practice Address - Street 1:719 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3040
Practice Address - Country:US
Practice Address - Phone:860-216-5758
Practice Address - Fax:860-461-0822
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001370251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health