Provider Demographics
NPI:1174959522
Name:MCPEAKE, OWEN (MAC, DOM)
Entity type:Individual
Prefix:MR
First Name:OWEN
Middle Name:
Last Name:MCPEAKE
Suffix:
Gender:M
Credentials:MAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 TREICHLER RD
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-2034
Mailing Address - Country:US
Mailing Address - Phone:484-547-7999
Mailing Address - Fax:
Practice Address - Street 1:4026 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2112
Practice Address - Country:US
Practice Address - Phone:267-437-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist