MEDICARE: LAGORA A. OLIVER BROOKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101234783	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548255144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAGORA A. OLIVER BROOKS MD

Provider Business Mailing Address
First Line	:	2301 GENERAL BOOTH BLVD
Second Line	:	STE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7755
Country	:	US
Telephone Number	:	757-963-5500
Fax Number	:	757-275-9907

Provider Business Practice Location Address
First Line	:	2301 GENERAL BOOTH BLVD
Second Line	:	STE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7755
Country	:	US
Telephone Number	:	757-963-5500
Fax Number	:	757-275-9907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/11/2014

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