Provider Demographics
NPI:1255846382
Name:PROK, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:PROK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 KEY PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4551
Mailing Address - Country:US
Mailing Address - Phone:240-629-3982
Mailing Address - Fax:240-629-3983
Practice Address - Street 1:1050 KEY PKWY STE 103
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4496
Practice Address - Country:US
Practice Address - Phone:240-629-3939
Practice Address - Fax:240-629-3940
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant