Provider Demographics
NPI:1639114523
Name:ALLCOCK, EDWARD G (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:ALLCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 N GEORGE MASON DR STE 305
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3655
Mailing Address - Country:US
Mailing Address - Phone:703-248-0006
Mailing Address - Fax:703-248-0007
Practice Address - Street 1:1715 N GEORGE MASON DR STE 305
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3655
Practice Address - Country:US
Practice Address - Phone:703-248-0006
Practice Address - Fax:703-248-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201670208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
248638OtherKAISER
P00215424OtherRAILROAD MEDICARE
MD005623500Medicaid
0001K171OtherFEDERAL BLUE CROSS
VA010113831Medicaid
175536OtherBLUE CROSS ANTHEM
2129380OtherMAM SI
G27128Medicare UPIN
MD005623500Medicaid