Provider Demographics
NPI:1255347852
Name:PECK, ERIC P (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:PECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEAVER DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2440
Mailing Address - Country:US
Mailing Address - Phone:814-371-2273
Mailing Address - Fax:814-371-2500
Practice Address - Street 1:90 BEAVER DR
Practice Address - Street 2:BUILDING C
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2440
Practice Address - Country:US
Practice Address - Phone:814-371-2273
Practice Address - Fax:814-371-2500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010983-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018251700002Medicaid
PAP00663727OtherRAILROAD MEDICARE
PA61854OtherGEISINGER
PA2078210OtherBLUE SHIELD
PAV0075DOtherUPMC
PA043913Medicare ID - Type Unspecified
PA0018251700002Medicaid