Provider Demographics
NPI:1679262703
Name:BROOKS, DERICK
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 HARTZDALE DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7200
Mailing Address - Country:US
Mailing Address - Phone:717-542-0569
Mailing Address - Fax:
Practice Address - Street 1:3401 HARTZDALE DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7200
Practice Address - Country:US
Practice Address - Phone:717-542-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No341600000XTransportation ServicesAmbulance