Healthcare Provider Details

I. General information

NPI: 1881886166
Provider Name (Legal Business Name): JASON CLIFFORD BROOKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST NELSON 2 133
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

PO BOX 64382
BALTIMORE MD
21264-4382
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5608
  • Fax:
Mailing address:
  • Phone: 410-955-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number221786
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD439683
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD439683
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD72455
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD72455
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: