Provider Demographics
NPI:1316987001
Name:PEASAK, DAVID P II (MSN, NP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:PEASAK
Suffix:II
Gender:
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 J D ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3494
Mailing Address - Country:US
Mailing Address - Phone:304-598-1200
Mailing Address - Fax:304-598-1699
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-598-1200
Practice Address - Fax:304-598-1699
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001722042OtherBCBS
WVP00287918OtherRAILROAD MEDICARE
WV7103213000Medicaid
WVWV54117OtherTHP
WVWV54117OtherTHP
WVP00287918OtherRAILROAD MEDICARE