Provider Demographics
NPI:1790720928
Name:BOCK, BRIAN T (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:BOCK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:658 HARLEYSVILLE PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2824
Mailing Address - Country:US
Mailing Address - Phone:215-256-9655
Mailing Address - Fax:215-256-9868
Practice Address - Street 1:658 HARLEYSVILLE PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2824
Practice Address - Country:US
Practice Address - Phone:215-256-9655
Practice Address - Fax:215-256-9868
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006152-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1197049OtherCIGNA
PA0299249000OtherKEYSTONE
PA4216167OtherAETNA
PAB0114016OtherBLUE SHIELD
PA0299249000OtherKEYSTONE
PAE76302Medicare UPIN