1790814929 NPI number — MRS. KATHRYN FRANCES BROOKS MD

Table of content: MRS. KATHRYN FRANCES BROOKS MD (NPI 1790814929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790814929 NPI number — MRS. KATHRYN FRANCES BROOKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
KATHRYN
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCORMICK
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790814929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 COMMERCIAL LANE
Provider Second Line Business Mailing Address:
GODWIN BLDG ON RT 10, SUITE 220
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23434-8149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-668-2600
Provider Business Mailing Address Fax Number:
757-668-2620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 COMMERCIAL LANE
Provider Second Line Business Practice Location Address:
GODWIN BLDG ON RT 10, SUITE 220
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23434-8149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-668-2600
Provider Business Practice Location Address Fax Number:
757-668-2620
Provider Enumeration Date:
03/05/2007

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: 208000000X , with the licence number:  0101241238 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010419913 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5906048 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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