Provider Demographics
NPI:1528063195
Name:PEACOCK, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:PEACOCK
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 1:915 LAWN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1551
Mailing Address - Country:US
Mailing Address - Phone:215-453-3300
Mailing Address - Fax:215-453-3306
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-453-3300
Practice Address - Fax:215-453-3306
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027674E207RH0003X
NJMA42423207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010069020004Medicaid
PA070833Medicare PIN
PAB34913Medicare UPIN
PA0010069020004Medicaid
PA0541786OtherAETNA #
PA01027701OtherCAPITAAL BLUE CROSS #
NJ808754Medicare ID - Type UnspecifiedNJ MEDICARE #
PA70833Medicare ID - Type UnspecifiedMEDICARE PA #