Provider Demographics
NPI:1891756615
Name:PECK, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
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 1:14 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9203
Mailing Address - Country:US
Mailing Address - Phone:570-419-7382
Mailing Address - Fax:
Practice Address - Street 1:14 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-9203
Practice Address - Country:US
Practice Address - Phone:570-419-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021080E207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006326510001Medicaid
PA003527F6KMedicare PIN
B29914Medicare UPIN
PAB29914OtherHEALTHAMERICA
PA003527OtherHIGHMARK BLUE SHIELD
PA16900OtherGEISINGER HEALTH PLAN
PA001724OtherFIRST PRIORITY HEALTH
PA080158745Medicare PIN
PA0006326510001Medicaid
PA003527Medicare PIN