MEDICARE: DR. BROOKS TABER 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	2085R0202X	Diagnostic Radiology Physician	2007-00613	NC
2	2085R0202X	Diagnostic Radiology Physician	0101270568	VA

General Provider Information

NPI Number	:	1679789002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKS TABER M.D.

Provider Business Mailing Address
First Line	:	5220 GREENS DAIRY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-4612
Country	:	US
Telephone Number	:	919-781-1437
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 BLUE RIDGE RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8087
Country	:	US
Telephone Number	:	919-781-1437
Fax Number	:	919-787-4870

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/28/2023

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