Provider Demographics
NPI:1356769772
Name:PEACH, MATTHEW SEAN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SEAN
Last Name:PEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1180 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7191
Mailing Address - Country:US
Mailing Address - Phone:434-249-8001
Mailing Address - Fax:
Practice Address - Street 1:1180 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7191
Practice Address - Country:US
Practice Address - Phone:434-249-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-015632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology