Provider Demographics
NPI:1780728188
Name:BOCK, JOANNA M (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:M
Last Name:BOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41816 FENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8069
Mailing Address - Country:US
Mailing Address - Phone:347-761-7200
Mailing Address - Fax:
Practice Address - Street 1:41816 FENWAY CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-8069
Practice Address - Country:US
Practice Address - Phone:347-761-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116776207R00000X
VA0101259225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01396279OtherRAILROAD MEDICARE PROVIDER NUMBER
FL012948100Medicaid
FLHX574ZMedicare PIN