Provider Demographics
NPI:1699734848
Name:PEACOCK, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:PEACOCK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:15940 NORTHCROSS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5062
Mailing Address - Country:US
Mailing Address - Phone:704-896-7005
Mailing Address - Fax:704-896-7115
Practice Address - Street 1:15940 NORTHCROSS DR
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5062
Practice Address - Country:US
Practice Address - Phone:704-896-7005
Practice Address - Fax:704-896-7115
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-10-31
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Provider Licenses
StateLicense IDTaxonomies
NC30568207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966374Medicaid
NC8966374Medicaid
NC2322476Medicare PIN