Healthcare Provider Details

I. General information

NPI: 1982693222
Provider Name (Legal Business Name): MICHELLE M BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD ALEXANDRIA HOSPITAL
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

20010 CENTURY BLVD STE 200
GERMANTOWN MD
20874-1118
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3066
  • Fax: 703-504-3866
Mailing address:
  • Phone: 240-686-2300
  • Fax: 240-686-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101232658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: