1285720581 NPI number — BROOKE ROSMAN BOKOR MD, MPH

Table of content: BROOKE ROSMAN BOKOR MD, MPH (NPI 1285720581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285720581 NPI number — BROOKE ROSMAN BOKOR MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOKOR
Provider First Name:
BROOKE
Provider Middle Name:
ROSMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

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:
1285720581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MICHIGAN AVE NW
Provider Second Line Business Mailing Address:
SUITE 400, WW 3.5, ADOLESCENT MEDICINE
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010-2978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-476-5000
Provider Business Mailing Address Fax Number:
202-476-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22505 LANDMARK CT # 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20148-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-472-4300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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: 2080A0000X , with the licence number:  0101270178 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: MD035544 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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