Provider Demographics
NPI:1245326040
Name:BOCK, ANTHONY JON (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JON
Last Name:BOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YORK HOSPITAL
Mailing Address - Street 2:15 HOSPITAL DRIVE
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-351-2170
Mailing Address - Fax:
Practice Address - Street 1:YORK HOSPITAL
Practice Address - Street 2:15 HOSPITAL DRIVE
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-351-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15954207P00000X
ME015071207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078391Medicaid
BO MM8635Medicare ID - Type Unspecified