Provider Demographics
NPI:1043400492
Name:PECOY-WHITCOMB, ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:PECOY-WHITCOMB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:3400 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1113
Practice Address - Country:US
Practice Address - Phone:413-794-9560
Practice Address - Fax:413-794-5884
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4891363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA4891OtherMASSACHUSETTS PA LICENSE
CAPA19390OtherCA PA LICENSE
CA1043400492 OR PA1939Medicaid
MAMP0937524JOtherMASSACHUSETTS DEA
MAPA4891OtherMASSACHUSETTS PA LICENSE
CAPA19390OtherCA PA LICENSE