Active NPI
Stephen Hunt Peacock, MD
- General Practice Physician
- Bethesda, MD
National Provider Identifier
1558866392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 2019-01904
- Practice address
- Walter Reed National Military Medical Center
4494 Palmer Rd N
Bethesda, MD 20814 - Phone
- (252) 314-5200
- NPI assigned
- Mar 26, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 2019-01904 | NC | Primary |
Addresses
Primary practice location
Walter Reed National Military Medical Center
4494 Palmer Rd N
Bethesda, MD 20814
Mailing address
4494 Palmer Rd N
4494 Palmer Rd N
Bethesda, MD 20814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019-01904 | NC | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1558866392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4494 PALMER RD N",
"address_2": "4494 PALMER RD N",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WALTER REED NATIONAL MILITARY MEDICAL CENTER",
"address_2": "4494 PALMER RD N",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20814",
"telephone_number": "252-314-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "STEPHEN",
"middle_name": "HUNT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-26",
"last_updated": "2023-08-15",
"certification_date": "2023-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NC",
"license": "2019-01904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.