Provider Demographics
NPI:1407854029
Name:BROOKS, RODNEY W (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:W
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 PENNSYLVANIA AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4354
Mailing Address - Country:US
Mailing Address - Phone:202-546-4504
Mailing Address - Fax:410-544-6136
Practice Address - Street 1:660 PENNSYLVANIA AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4354
Practice Address - Country:US
Practice Address - Phone:202-546-4504
Practice Address - Fax:410-544-6136
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39175Medicare UPIN