Provider Demographics
NPI:1982867552
Name:BLOCK, MIRIAM F (PA)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:F
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10719 GLOXINIA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3442
Mailing Address - Country:US
Mailing Address - Phone:301-770-6837
Mailing Address - Fax:
Practice Address - Street 1:2250 CHAMPLAIN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2618
Practice Address - Country:US
Practice Address - Phone:202-232-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA12363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical