Healthcare Provider Details

I. General information

NPI: 1760927495
Provider Name (Legal Business Name): THOMAS ROELOF BROOKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS R BROOKE

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE INTERNAL MEDICINE CLINIC, BLDG 19
BETHESDA MD
20814
US

IV. Provider business mailing address

8901 WISCONSIN AVENUE INTERNAL MEDICINE CLINIC, BLDG 19
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0196
  • Fax: 301-400-0618
Mailing address:
  • Phone: 301-295-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101270480
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101270480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: