Provider Demographics
NPI:1366437717
Name:PECKMAN, MARK ANDREW (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:PECKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOWN CENTER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8312
Mailing Address - Country:US
Mailing Address - Phone:330-482-3762
Mailing Address - Fax:330-482-3840
Practice Address - Street 1:400 TOWN CENTER AVE STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8312
Practice Address - Country:US
Practice Address - Phone:330-482-3762
Practice Address - Fax:330-482-3840
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005181P207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0617176Medicaid
OHF70323Medicare UPIN
OHPE0805608Medicare Oscar/Certification