Provider Demographics
NPI:1558337600
Name:BROOKS, ROBERT W (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-595-2505
Practice Address - Fax:508-854-0650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA56741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3900115OtherEVERCARE
8275200OtherCIGNA HEALTH PLAN
J09423OtherBLUE CARE ELECT
5978215OtherAETNA US HEALTHCARE
J09423OtherBLUE SHIELD HMO BLUE
3098028OtherMEDICAID WELFARE
1150009OtherFIRST HEALTH
26778OtherCHILDRENS MED SEC PLAN
J09423OtherBLUE SHIELD INDEMNITY
26778OtherHEALTHY START
373636OtherMVP HEALTH CARE
AA5960OtherHARVARD PILGRIM HEALTHCAR
MA3098028Medicaid
9900867OtherFALLON COMMUNITY HEALTH P
J09423OtherMEDICARE B
9900867OtherFALLON COMMUNITY HEALTH P
MA3098028Medicaid