Provider Demographics
NPI:1790998458
Name:BOCEK, PETR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PETR
Middle Name:
Last Name:BOCEK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20528 BOLAND FARM RD STE 214
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4038
Mailing Address - Country:US
Mailing Address - Phone:855-528-7348
Mailing Address - Fax:855-329-2873
Practice Address - Street 1:8100 ASHTON AVE STE 207B
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5688
Practice Address - Country:US
Practice Address - Phone:855-528-7348
Practice Address - Fax:855-329-2873
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061993174400000X, 207K00000X
VA0101223417174400000X
VA0101342217207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist