Provider Demographics
NPI:1952677387
Name:BROOKS, CORINNE FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:FRANCES
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:FRANCES
Other - Last Name:STALZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-376-7111
Mailing Address - Fax:724-376-7165
Practice Address - Street 1:3205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDY LAKE
Practice Address - State:PA
Practice Address - Zip Code:16145
Practice Address - Country:US
Practice Address - Phone:724-376-7111
Practice Address - Fax:724-376-7165
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453869208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029965120004Medicaid