Provider Demographics
NPI:1740479807
Name:WILLAIM J PEGG, MD, PC
Entity type:Organization
Organization Name:WILLAIM J PEGG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-771-4850
Mailing Address - Street 1:PO BOX 2460
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-2460
Mailing Address - Country:US
Mailing Address - Phone:508-548-3699
Mailing Address - Fax:508-548-6036
Practice Address - Street 1:26 GLEASON ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5223
Practice Address - Country:US
Practice Address - Phone:507-771-4850
Practice Address - Fax:508-771-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18057OtherBLUE SHIELD
MA131526OtherHARVARD PILGRIM
MA729704OtherTUFTS
MA9725890Medicaid
MA=========OtherTRICARE
MA131526OtherHARVARD PILGRIM
MA9725890Medicaid