Provider Demographics
NPI:1497416630
Name:DADDS, BROOKE ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:DADDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOFFECKER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1972
Mailing Address - Country:US
Mailing Address - Phone:443-786-3913
Mailing Address - Fax:
Practice Address - Street 1:600 HOFFECKER RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1972
Practice Address - Country:US
Practice Address - Phone:443-786-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant