| Doctor Name: | MS. ANITA BROCK |
| NPI Number: | 1902134828 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PAC |
| License Number: | PA030636 |
| Business Practice Address: | 207 Farmington Road West Accokeek, MD - 20607 |
| Business Phone Number: | 5712691509 |
| Business Fax Number: | |
| Mailing Address: | 207 Farmington Road West, ACCOKEEK |
| State: | MD |
| Postal Code: | 20607 |
| Phone Number: | 5712691509 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2009 |
| NPI Last Update Date: | 12/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA030636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |