Individual
DR. PHILIP R PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8100 ASHTON AVE, SUITE 101, MANASSAS, VA 20109
(703) 257-8090
(703) 257-7822
Mailing address
950N GLEBE RD 4000, ARLINGTON, VA 22203-1824
(571) 295-7514
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102036935
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05859361
—
VA
01
—
080175699
RR MEDICARE
—
Enumeration date
09/01/2005
Last updated
11/27/2023
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