Provider Demographics
NPI:1568439768
Name:MCBROOM, JOHN WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARREN
Last Name:MCBROOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-6120
Mailing Address - Fax:717-409-6223
Practice Address - Street 1:25 MONUMENT RD STE 295
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5049
Practice Address - Country:US
Practice Address - Phone:717-851-6120
Practice Address - Fax:717-409-6223
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD90981207VX0201X
PAMD460521207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003103996FMedicaid
GA003103996DMedicaid
GA2020I21060Medicare PIN