Individual
DR. BROCK JOSEPH OLIVERIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1610
(681) 342-1626
Mailing address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1610
(681) 342-1626
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
22630
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4255651
MEDICARE PTAN
WV
Enumeration date
07/19/2007
Last updated
02/28/2014
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