Provider Demographics
NPI:1841833092
Name:BROOKS, SAMUEL CHASE (PA-C)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:CHASE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WALNUT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2034
Mailing Address - Country:US
Mailing Address - Phone:706-983-1900
Mailing Address - Fax:
Practice Address - Street 1:1029 YORK ST NE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4025
Practice Address - Country:US
Practice Address - Phone:803-648-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant