Provider Demographics
NPI:1790814929
Name:BROOKS, KATHRYN FRANCES (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:FRANCES
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:FRANCES
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1005 COMMERCIAL LANE
Mailing Address - Street 2:GODWIN BLDG ON RT 10, SUITE 220
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8149
Mailing Address - Country:US
Mailing Address - Phone:757-668-2600
Mailing Address - Fax:757-668-2620
Practice Address - Street 1:1005 COMMERCIAL LANE
Practice Address - Street 2:GODWIN BLDG ON RT 10, SUITE 220
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8149
Practice Address - Country:US
Practice Address - Phone:757-668-2600
Practice Address - Fax:757-668-2620
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010419913Medicaid
NC5906048Medicaid