Healthcare Provider Details

I. General information

NPI: 1386946275
Provider Name (Legal Business Name): W. ABDULLAH BROOKS MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2010
Last Update Date: 11/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HOUNDSWOOD CT
BALTIMORE MD
21209-1067
US

IV. Provider business mailing address

18 HOUNDSWOOD CT
BALTIMORE MD
21209-1067
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-5511
  • Fax: 503-210-0453
Mailing address:
  • Phone: 443-722-5511
  • Fax: 503-210-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0046523
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: