Healthcare Provider Details

I. General information

NPI: 1679114557
Provider Name (Legal Business Name): BROOKE ADELE CERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GATEWAY DR
BEL AIR MD
21014-4268
US

IV. Provider business mailing address

114 CHAPELTOWNE CIR
NOTTINGHAM MD
21236-1251
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-2227
  • Fax:
Mailing address:
  • Phone: 814-937-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberUO2427
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: