Provider Demographics
NPI:1043744725
Name:BROOKS, DERRICK M (MD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 15TH ST NW 600
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-2610
Mailing Address - Country:US
Mailing Address - Phone:202-743-5817
Mailing Address - Fax:860-879-3433
Practice Address - Street 1:1015 15TH ST NW STE 600
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-2605
Practice Address - Country:US
Practice Address - Phone:202-743-5817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4683502084P0800X
390200000X
DCMD2000013852084P0800X
VA01012728012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program