Provider Demographics
NPI:1942420906
Name:PECK, MARTHA G (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:G
Last Name:PECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:JEAN
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:919-994-6331
Mailing Address - Fax:919-590-6777
Practice Address - Street 1:7033 LOUIS STEPHENS DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6399
Practice Address - Country:US
Practice Address - Phone:919-994-6331
Practice Address - Fax:919-590-6777
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCO180AOtherMEDICARE
NC2074078Medicare UPIN