Healthcare Provider Details

I. General information

NPI: 1700215563
Provider Name (Legal Business Name): MERRIAN JACQUELINE BROOKS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 5TH AVE DIVISION OF ADOLESCENT AND YOUNG ADULT MEDICINE
PITTSBURGH PA
15213-3205
US

IV. Provider business mailing address

3420 5TH AVE DIVISION OF ADOLESCENT AND YOUNG ADULT MEDICINE
PITTSBURGH PA
15213-3205
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-6677
  • Fax: 412-692-8584
Mailing address:
  • Phone: 412-692-6677
  • Fax: 412-692-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS017178
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberOT014985
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: