Peacock, Philip R

Peacock, Philip R is an individual health care provider with primary practice located at 8100 Ashton Ave Suite 101, Manassas VA 20109. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Peacock, Philip R can be contacted via phone (703) 257-8090.

Contact Information

Primary practice address
8100 Ashton Ave Suite 101 Manassas VA 20109
Phone: (703) 257-8090
Fax: (703) 257-7822
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0102036935 Virginia

Profile Details

NPI number 1467446740
LBN Legal business name Peacock, Philip R
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 1st, 2005
Last updated Nov 27th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467446740 NPPES
Virginia MEDICAID 05859361
Virginia Other 080175699

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