Provider Demographics
NPI:1356508428
Name:BROOKSHIRE, LAURA TERESA (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:TERESA
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9512 HARFORD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3100
Mailing Address - Country:US
Mailing Address - Phone:410-882-0600
Mailing Address - Fax:410-882-2133
Practice Address - Street 1:9512 HARFORD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3100
Practice Address - Country:US
Practice Address - Phone:410-882-0600
Practice Address - Fax:410-882-2133
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH80972208000000X
FLOS10380208000000X, 208D00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002044000Medicaid