Individual
DR. SAMANTHA GWEN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1060 W PERIMETER RD # R, JB ANDREWS, MD 20762-6602
(240) 612-2464
Mailing address
1060 W PERIMETER RD RM 3K43, JB ANDREWS, MD 20762-6602
(240) 612-2464
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01083831A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
04/10/2018
Last updated
09/05/2024
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