Basic Information
| Provider Information | |||||||||
| NPI: | 1720432867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCPEEK | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1741 ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212051531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439231842 | ||||||||
| FaxNumber: | 4439231835 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026515874 | ||||||||
| FaxNumber: | 3026515954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | DC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | C1-0013175 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.