Provider Demographics
NPI:1285713123
Name:PECK, WILLIAM B (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:81 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9835
Mailing Address - Country:US
Mailing Address - Phone:802-334-4110
Mailing Address - Fax:802-334-4113
Practice Address - Street 1:81 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9835
Practice Address - Country:US
Practice Address - Phone:802-334-4110
Practice Address - Fax:802-334-4113
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT0420006021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0572880001OtherDME
VT15842OtherMVP
VT8000226OtherLADIES FIRST
VT00005263OtherBLUE SHIELD OF VERMONT
VT0005263Medicaid
NH99005263Medicaid
VT0572880001OtherDME
VT00005263OtherBLUE SHIELD OF VERMONT