Provider Demographics
NPI:1871675868
Name:LAWRENCE R PECK DO PC
Entity Type:Organization
Organization Name:LAWRENCE R PECK DO PC
Other - Org Name:MORRISVILLE-YARDLEY FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-736-9362
Mailing Address - Street 1:312 W TRENTON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2041
Mailing Address - Country:US
Mailing Address - Phone:215-736-9362
Mailing Address - Fax:215-736-8050
Practice Address - Street 1:312 W TRENTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-2041
Practice Address - Country:US
Practice Address - Phone:215-736-9362
Practice Address - Fax:215-736-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007297-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID NUMBER
PA900876Medicare PIN