MEDICARE: MARECHAL-NEIL BROOKS M.D.

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	207RG0100X	Gastroenterology Physician	0101044736	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110034810	OTHER	VA	MEDICARE/RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	099019	OTHER	VA	ANTHEM BC/BS
4	15960	OTHER	VA	SENTARA HEALTH PLAN
5	528874	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1629089768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARECHAL-NEIL BROOKS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2554
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-2554
Country	:	US
Telephone Number	:	757-627-6038
Fax Number	:	757-627-3862

Provider Business Practice Location Address
First Line	:	930 MAJESTIC AVE
Second Line	:	STE. 210
City	:	NORFOLK
State	:	VA
Zip	:	23504-4055
Country	:	US
Telephone Number	:	757-627-6038
Fax Number	:	757-627-3868

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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Directions to “ MARECHAL-NEIL BROOKS M.D.” Practice Location

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