Provider Demographics
NPI:1295947992
Name:BROOKS, HEATHER D (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
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 1:2013 JEFFERSON ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2419
Mailing Address - Country:US
Mailing Address - Phone:540-982-0237
Mailing Address - Fax:540-982-2719
Practice Address - Street 1:2955 MARKET ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6575
Practice Address - Country:US
Practice Address - Phone:540-381-5291
Practice Address - Fax:540-381-7857
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00278207RH0003X
VA0101253014207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295947992Medicaid
TX201076102Medicaid
NC5918062Medicaid
SCNC1393Medicaid
SCNC1393Medicaid
NC5918062Medicaid