Provider Demographics
NPI:1780010892
Name:PARKS, BROOKE L (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BROOK
Other - Middle Name:L
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 CROSSROADS DR STE 400
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5490
Mailing Address - Country:US
Mailing Address - Phone:410-356-2626
Mailing Address - Fax:410-356-8945
Practice Address - Street 1:23 CROSSROADS DR STE 400
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5490
Practice Address - Country:US
Practice Address - Phone:410-356-2626
Practice Address - Fax:410-356-8945
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant