Basic Information
| Provider Information | |||||||||
| NPI: | 1194170076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
| FaxNumber: | 8666034163 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
| FaxNumber: | 8666034163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2016 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 62168 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.