Active NPI
Brock Joseph Oliverio, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Bridgeport, WV
National Provider Identifier
1295935104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 22630
- Practice address
- 327 Medical Park Dr
Bridgeport, WV 26330-9006 - Phone
- (681) 342-1610
- Fax
- (681) 342-1626
- NPI assigned
- Jul 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 22630 | WV | Primary |
Addresses
Primary practice location
327 Medical Park Dr
Bridgeport, WV 26330-9006
Mailing address
327 Medical Park Dr
Bridgeport, WV 26330-9006
Phone (681) 342-1610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4255651 | Other | WV | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22630 | WV | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393545600000",
"number": "1295935104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "327 MEDICAL PARK DR",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263309006",
"telephone_number": "681-342-1610",
"fax_number": "681-342-1626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "327 MEDICAL PARK DR",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263309006",
"telephone_number": "681-342-1610",
"fax_number": "681-342-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVERIO",
"first_name": "BROCK",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-19",
"last_updated": "2014-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "WV",
"license": "22630",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "4255651",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.