Provider Demographics
NPI:1518992072
Name:BROOKS, REBECCA MATER (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MATER
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5201
Mailing Address - Country:US
Mailing Address - Phone:252-636-6222
Mailing Address - Fax:252-636-5385
Practice Address - Street 1:670 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5201
Practice Address - Country:US
Practice Address - Phone:252-636-6222
Practice Address - Fax:252-636-5385
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC9701263207P00000X
NC9701263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014MXOtherBCBS LABS
NC235013OtherMEDICARE PHYSICIAN
NC00513OtherBCBS
NC0081POtherBCBS SWINGBED
NC11944OtherBCBS INDIVIDUAL PROVIDER
NC34U011OtherMEDICARE SWINGBED
NC411013849OtherMEDICARE RAILROAD
NC07673OtherBCBS PHYSICIAN
NC8907673OtherMEDICAID PHYSICIAN
NC235013BOtherMEDICARE PHYSICIAN
NC3400011OtherMEDICAID
NC8911944Medicaid
NC235013BOtherMEDICARE PHYSICIAN
NC3400011OtherMEDICAID
G89344Medicare UPIN
NC2263609DMedicare PIN