Provider Demographics
NPI:1629089768
Name:BROOKS, MARECHAL-NEIL (MD)
Entity Type:Individual
Prefix:
First Name:MARECHAL-NEIL
Middle Name:
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:PO BOX 2554
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-2554
Mailing Address - Country:US
Mailing Address - Phone:757-627-6038
Mailing Address - Fax:757-627-3862
Practice Address - Street 1:930 MAJESTIC AVE
Practice Address - Street 2:STE. 210
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4055
Practice Address - Country:US
Practice Address - Phone:757-627-6038
Practice Address - Fax:757-627-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044736207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110034810OtherMEDICARE/RAILROAD
VA006036503Medicaid
VA099019OtherANTHEM BC/BS
VA15960OtherSENTARA HEALTH PLAN
VA528874OtherMAMSI
VA099019OtherANTHEM BC/BS
VA15960OtherSENTARA HEALTH PLAN