1265488837 NPI number — ROGER W BROOKE PH.D.

Table of content: ROGER W BROOKE PH.D. (NPI 1265488837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265488837 NPI number — ROGER W BROOKE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKE
Provider First Name:
ROGER
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265488837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 PENN AVE
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
WILKINSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15221-2154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-371-7330
Provider Business Mailing Address Fax Number:
412-242-4732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 PENN AVE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
WILKINSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15221-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-371-7330
Provider Business Practice Location Address Fax Number:
412-242-4732
Provider Enumeration Date:
05/25/2006

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: 103TC0700X , with the licence number:  PS007832L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118389 . This is a "VALUEOPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1601598 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 526417 . This is a "HIGHMARK BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 680008001 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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