Healthcare Provider Details

I. General information

NPI: 1285720581
Provider Name (Legal Business Name): BROOKE ROSMAN BOKOR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22505 LANDMARK CT # 225
ASHBURN VA
20148-6500
US

IV. Provider business mailing address

111 MICHIGAN AVE NW SUITE 400, WW 3.5, ADOLESCENT MEDICINE
WASHINGTON DC
20010-2978
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4300
  • Fax:
Mailing address:
  • Phone: 202-476-5000
  • Fax: 202-476-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101270178
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD035544
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: