Healthcare Provider Details

I. General information

NPI: 1174560122
Provider Name (Legal Business Name): JOHN CARTER BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SHADY AVE SUITE A 107
PITTSBURGH PA
15206-4409
US

IV. Provider business mailing address

401 SHADY AVE SUITE A 107
PITTSBURGH PA
15206-4409
US

V. Phone/Fax

Practice location:
  • Phone: 412-441-3305
  • Fax: 412-441-3324
Mailing address:
  • Phone: 412-441-3305
  • Fax: 412-441-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD050105L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: