Individual
BOBBY LEWIS COCKRAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3300
(703) 776-4001
(703) 776-7113
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001402
VA
363AM0700X
Medical Physician Assistant
0110001402
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010392055
—
VA
05
—
1689601320
—
VA
01
—
P00453916
RAILROAD MEDICARE
VA
01
—
P00679650
MEDICARE RAILROAD
VA
Enumeration date
06/27/2006
Last updated
09/22/2020
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