Healthcare Provider Details

I. General information

NPI: 1396855938
Provider Name (Legal Business Name): RICHARD ROBERT BROOKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E MARSHALL ST
RICHMOND VA
23298-5075
US

IV. Provider business mailing address

PO BOX 980151
RICHMOND VA
23298-0151
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9408
  • Fax: 804-628-0375
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101032846
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101032846
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: