Provider Demographics
NPI:1063732055
Name:ASSERES, BROOKTIETE (MD)
Entity type:Individual
Prefix:
First Name:BROOKTIETE
Middle Name:
Last Name:ASSERES
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 1:3569 WILLOW GREEN DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2507
Mailing Address - Country:US
Mailing Address - Phone:240-338-1418
Mailing Address - Fax:
Practice Address - Street 1:3569 WILLOW GREEN DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2507
Practice Address - Country:US
Practice Address - Phone:240-338-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD97797208000000X
NC2013-01617208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1513788OtherWELLPATH
NC247602OtherMEDCOST, LLC
NC3652537OtherUNITED HEALTHCARE
NC7520999OtherAETNA
NC1063732055OtherDOCTORS DIRECT
NC1063732055Medicaid
NC1063732055OtherHEALTHNET FEDERAL SERVICES
NC1063732055OtherHUMANA
NC13305729OtherPHCS-MULTIPLAN
NC1513788OtherCOVENTRY OF THE CAROLINAS
NC1806POtherBCBS OF NC
NC9225005OtherCIGNA-GREATWEST
NCFH1101395OtherFIRST CAROLINA CARE
NC1063732055OtherHEALTHSMART
NC4468100OtherCOVENTRY NATIONAL - COVENTRY PPO