Provider Demographics
NPI:1740254507
Name:MCPEAK, KATIE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELIZABETH
Last Name:MCPEAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 A ST
Mailing Address - Street 2:PRIMARY PEDIATRICS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1043
Mailing Address - Country:US
Mailing Address - Phone:303-915-9016
Mailing Address - Fax:215-427-6791
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:PRIMARY PEDIATRICS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:303-915-9016
Practice Address - Fax:215-427-6791
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101210749Medicaid
PA089594EBOMedicare ID - Type Unspecified
PA101210749Medicaid