Healthcare Provider Details

I. General information

NPI: 1912931643
Provider Name (Legal Business Name): ANDREW B BLOCK M.D., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MEDICAL PARK DR STE 200E
SILVER SPRING MD
20902
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 301-468-0073
  • Fax: 240-283-8412
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0039653
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: