Anita Brock, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA030636 Issued in DC

Practice address

207 Farmington Road West
Accokeek, MD 20607

Phone

(571) 269-1509

NPI assigned

Dec 4, 2009

Last updated

Dec 4, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259884800000",
    "number": "1902134828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 FARMINGTON ROAD WEST",
            "city": "ACCOKEEK",
            "state": "MD",
            "postal_code": "20607",
            "telephone_number": "571-269-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FARMINGTON ROAD WEST",
            "city": "ACCOKEEK",
            "state": "MD",
            "postal_code": "20607",
            "telephone_number": "571-269-1509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "ANITA",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-04",
        "last_updated": "2009-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "DC",
            "license": "PA030636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAC LICENSE",
            "identifier": "PA030636",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Accokeek, MD
• Providers in Accokeek, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.