Provider Demographics
NPI:1578266755
Name:STROCK, DANIEL MITCHELL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MITCHELL
Last Name:STROCK
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 1:413 CULPEPER ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2270
Mailing Address - Country:US
Mailing Address - Phone:540-538-2965
Mailing Address - Fax:
Practice Address - Street 1:700 W OLNEY RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1607
Practice Address - Country:US
Practice Address - Phone:540-538-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program