Provider Demographics
NPI:1386688877
Name:PECK, COURTNEY (PA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PECK
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 1:20 GUEST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2040
Mailing Address - Country:US
Mailing Address - Phone:617-475-0496
Mailing Address - Fax:213-265-9954
Practice Address - Street 1:20 GUEST ST STE 200
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2040
Practice Address - Country:US
Practice Address - Phone:617-475-0496
Practice Address - Fax:213-265-9954
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2025-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110161947AMedicaid
RI007008385Medicare ID - Type Unspecified
P03519Medicare UPIN