Provider Demographics
NPI:1982772778
Name:BLOCH, ANDREW G (MSPT,ATC,DOM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:BLOCH
Suffix:
Gender:M
Credentials:MSPT,ATC,DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46B WEST GUDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4358
Mailing Address - Country:US
Mailing Address - Phone:240-361-2225
Mailing Address - Fax:240-361-0719
Practice Address - Street 1:46B WEST GUDE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4358
Practice Address - Country:US
Practice Address - Phone:240-361-2225
Practice Address - Fax:240-361-0719
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01848171100000X
MD23495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH874OtherBCBS
MDLY91PAOtherBCBS PPO