Provider Demographics
NPI:1972563922
Name:BOCK, SANDRA GAY (PA-C, MED)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GAY
Last Name:BOCK
Suffix:
Gender:F
Credentials:PA-C, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 BEECHNUT RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-3302
Mailing Address - Country:US
Mailing Address - Phone:781-769-0215
Mailing Address - Fax:
Practice Address - Street 1:VABOS 1400 VFW PKWY
Practice Address - Street 2:OCC HEALTH RM GA153
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:617-323-7700
Practice Address - Fax:857-203-5583
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14OtherMA PA LIC