Provider Demographics
NPI:1073604435
Name:BROOKS, KENNETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
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 1:3023 HAMAKER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2207
Mailing Address - Country:US
Mailing Address - Phone:703-641-9161
Mailing Address - Fax:703-641-0383
Practice Address - Street 1:3023 HAMAKER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2207
Practice Address - Country:US
Practice Address - Phone:703-641-9161
Practice Address - Fax:703-641-0383
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
541977219OtherCIGNA PROVIDER #
5726OtherCAREFIRST GROUP #
VA005842344Medicaid
432669OtherANTHEM PROVIDER #
4427684OtherAETNA PPOPOS PROVIDER #
541977219OtherNALC AFFORDABLE PROVIDER
541977219OtherMAMSI GROUP #
C08696OtherMEDICARE OF VA GROUP #
0002OtherCAREFIRST PROVIDER #
541977219OtherUNITED HEALTHCARE PROVIDE
541977219OtherALLIANCE GEHA GROUP #
57110OtherMAMSI PROVIDER #
00V372C96OtherMEDICARE OF VA PROVIDER #
259418OtherANTHEM GROUP #
541977219OtherMDIPA GROUP #
57110OtherMDIPA PROVIDER #
57110OtherALLIANCE GEHA PROVIDER #
737485OtherAETNA HMO PROVIDER #
57110OtherMAMSI PROVIDER #
C61696Medicare UPIN