Healthcare Provider Details

I. General information

NPI: 1295145167
Provider Name (Legal Business Name): BROOKE E ORGAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 AIR FORCE PENTAGON RM 4A870
WASHINGTON DC
20330-1284
US

IV. Provider business mailing address

1760 AIR FORCE PENTAGON RM 4A870
WASHINGTON DC
20330-1760
US

V. Phone/Fax

Practice location:
  • Phone: 703-697-3255
  • Fax:
Mailing address:
  • Phone: 703-697-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13475
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036157906
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.157906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: