Provider Demographics
NPI:1285690537
Name:BROOKS, MEGHAN MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:MARY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:RAYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1788 WILMINGTON PIKE STE 2200
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8182
Practice Address - Country:US
Practice Address - Phone:610-459-8044
Practice Address - Fax:610-558-1425
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009933L2080A0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019066990001Medicaid