1508861899 NPI number — CYNTHIA BROCK DO

Table of content: MISS JESSICA KAUR PETERS NP (NPI 1124465257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508861899 NPI number — CYNTHIA BROCK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROCK
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINSEN
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508861899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 COLEGATE DR BLDG 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45750-9549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-374-3526
Provider Business Mailing Address Fax Number:
740-374-3165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 E 8TH ST STE 151
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45750-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-374-4945
Provider Business Practice Location Address Fax Number:
740-374-4943
Provider Enumeration Date:
06/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34007080 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)