Provider Demographics
NPI:1427375633
Name:TOCKS, JESSICA LAUREN WIRTH (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LAUREN WIRTH
Last Name:TOCKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7800
Mailing Address - Fax:717-812-7811
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-7800
Practice Address - Fax:717-812-7811
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017042207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102949030-0001Medicaid
PA102949030-0001Medicaid
PA358927EZ3Medicare PIN