Provider Demographics
NPI:1891053195
Name:PEACHER-HOLDERIED, ANNACECILIA (MD)
Entity Type:Individual
Prefix:
First Name:ANNACECILIA
Middle Name:
Last Name:PEACHER-HOLDERIED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 3RD AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6212
Mailing Address - Country:US
Mailing Address - Phone:732-571-0972
Mailing Address - Fax:
Practice Address - Street 1:279 3RD AVE STE 307
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6212
Practice Address - Country:US
Practice Address - Phone:732-571-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10042803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology