Provider Demographics
NPI:1639323009
Name:BROOKE, LAURA B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:BROOKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6701 N CHARLES STREET
Mailing Address - Street 2:CHARLES EMERGENCY PHYSICIANS
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-2525
Mailing Address - Fax:610-834-2862
Practice Address - Street 1:6701 N CHARLES STREET
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-849-2525
Practice Address - Fax:443-849-3094
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0003848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant