Provider Demographics
NPI:1104907997
Name:PECKINPAUGH, JAMES MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:PECKINPAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 SOUTH CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6910
Mailing Address - Country:US
Mailing Address - Phone:704-938-4886
Mailing Address - Fax:704-938-5644
Practice Address - Street 1:2402 SOUTH CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6910
Practice Address - Country:US
Practice Address - Phone:704-938-4886
Practice Address - Fax:704-938-5644
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC66442OtherBLUE CROSS
NC8966442Medicaid
NC66442OtherBLUE CROSS
E67536Medicare UPIN