Kenneth Charles Peacock, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

25MA04603300 Issued in NJ

Practice address

523 Fellowship Rd Ste 275
Mount Laurel, NJ 08054-3445

Phone

(856) 235-7666

NPI assigned

Jul 14, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Laurel Evaluations

  • Legal Medicine
  • Mount Laurel, NJ
  • NPI 1346361128
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499990400000",
    "number": "1508388257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 ANONA DR",
            "city": "UPPER SADDLE RIVER",
            "state": "NJ",
            "postal_code": "074581103",
            "telephone_number": "203-609-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 FELLOWSHIP RD STE 275",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543445",
            "telephone_number": "856-235-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "KENNETH",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-14",
        "last_updated": "2017-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NJ",
            "license": "25MA04603300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAUREL EVALUATIONS, P.A.",
            "identifier": "13463603300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ripal Patel, PHARM. D.
• Paterno Orthodontics LLC
• Michele Paterno, DMD, MSD
• Paul L Vernon, MD, PA
• Peaceful Oasis Solutions LLC
• Ronald D Peak, D.C.
• Craig W Pearl, PSY D
• Steven R. Peikin, MD
• Daniel Pelaez, OTR L
• Joseph Pepitone, LPC

• Orthopaedic Surgery Physician in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Orthopaedic Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.