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Individual

MS. ANITA BROCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
207 FARMINGTON ROAD WEST, ACCOKEEK, MD 20607
(571) 269-1509
Mailing address
207 FARMINGTON ROAD WEST, ACCOKEEK, MD 20607
(571) 269-1509

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA030636
DC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA030636
PAC LICENSE
DC
Enumeration date
12/04/2009
Last updated
12/04/2009
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