Provider Demographics
NPI:1962546366
Name:BOCK, JEREMY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:BOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 354
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-7780
Mailing Address - Fax:703-717-7781
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 354
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-7780
Practice Address - Fax:703-717-7781
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2020-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101258619207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32154OtherBLUE CROSS
FL250569000Medicaid