Provider Demographics
NPI:1578579025
Name:BOCK, DEVON E (MD)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:E
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 1:391 MYRTLE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3797
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:PRUYN PAVILION AT GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-792-7122
Practice Address - Fax:518-792-3800
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1886182085R0204X, 208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574309Medicaid
NY01574309Medicaid
G21406Medicare UPIN