Provider Demographics
NPI:1295705929
Name:BROOKS, ANN MARIE (MD)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:43 SOKOKIS TRAIL
Practice Address - Street 2:
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030
Practice Address - Country:US
Practice Address - Phone:207-247-6742
Practice Address - Fax:207-247-6114
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
050562391OtherCOMMERCIAL
M555815OtherCIGNA NH
ME000216065Medicaid
ME046261OtherANTHEM
NH30205555Medicaid
O46261OtherANTHEM UPIN
046261OtherMAINE BS
ME252360099Medicaid
00555815OtherCHAMPUS
ME3179924OtherAETNA
ME252360099Medicaid