Provider Demographics
NPI:1073192233
Name:BOCKMAN, BRIANNA (MD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BOCKMAN
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-742-2655
Mailing Address - Fax:570-742-2886
Practice Address - Street 1:155 S ARCH ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-1172
Practice Address - Country:US
Practice Address - Phone:570-742-2655
Practice Address - Fax:570-742-2886
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD490612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine