Individual
DR. KENNETH M BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3023 HAMAKER CT, SUITE 100, FAIRFAX, VA 22031-2207
(703) 641-9161
(703) 641-0383
Mailing address
3023 HAMAKER CT, SUITE 100, FAIRFAX, VA 22031-2207
(703) 641-9161
(703) 641-0383
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101035361
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002
CAREFIRST PROVIDER #
—
05
—
005842344
—
VA
01
—
00V372C96
MEDICARE OF VA PROVIDER #
—
01
—
259418
ANTHEM GROUP #
—
01
—
432669
ANTHEM PROVIDER #
—
01
—
4427684
AETNA PPOPOS PROVIDER #
—
01
—
541977219
CIGNA PROVIDER #
—
01
—
57110
MAMSI PROVIDER #
—
01
—
5726
CAREFIRST GROUP #
—
01
—
737485
AETNA HMO PROVIDER #
—
01
—
C08696
MEDICARE OF VA GROUP #
—
Enumeration date
09/28/2006
Last updated
12/26/2012
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