Provider Demographics
NPI:1376238519
Name:BROOKS, JOSEPH DONALD
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DONALD
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2765
Mailing Address - Country:US
Mailing Address - Phone:603-801-5656
Mailing Address - Fax:
Practice Address - Street 1:158 GRANT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-2765
Practice Address - Country:US
Practice Address - Phone:603-801-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program