Provider Demographics
NPI:1972524361
Name:PECK, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8037 CORPORATE CENTER DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4550
Mailing Address - Country:US
Mailing Address - Phone:704-659-1052
Mailing Address - Fax:888-869-6879
Practice Address - Street 1:8037 CORPORATE CENTER DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4550
Practice Address - Country:US
Practice Address - Phone:704-659-1052
Practice Address - Fax:888-869-6879
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2003-008652084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H32959Medicare UPIN