Healthcare Provider Details

I. General information

NPI: 1558658740
Provider Name (Legal Business Name): DENNIS ALBERT BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD AEMC DEPT OF PEDIATRICS
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5501 OLD YORK RD AEMC DEPT OF PEDIATRICS
PHILADELPHIA PA
19141-3018
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8324
  • Fax: 215-456-3436
Mailing address:
  • Phone: 215-456-8324
  • Fax: 215-456-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD431015
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: