Healthcare Provider Details

I. General information

NPI: 1962793604
Provider Name (Legal Business Name): CHARELLE MONIQUE CARTER-BROOKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW STE 6A-42
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

106 BIDDLE AVE APT 2
WILKINSBURG PA
15221-3495
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3201
  • Fax:
Mailing address:
  • Phone: 518-429-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD454759
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: