Provider Demographics
NPI:1992965875
Name:BOCKELMAN, DAVID SCOTT (IDC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:BOCKELMAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:BOCKELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1683 GILBERT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-2731
Mailing Address - Country:US
Mailing Address - Phone:757-444-1105
Mailing Address - Fax:757-444-9412
Practice Address - Street 1:1683 GILBERT ST STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2731
Practice Address - Country:US
Practice Address - Phone:757-444-1105
Practice Address - Fax:757-444-9412
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman