Provider Demographics
NPI:1124291141
Name:BROOKE R SECKEL MD LLC
Entity type:Organization
Organization Name:BROOKE R SECKEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDISENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-4499
Mailing Address - Street 1:1 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2303
Mailing Address - Country:US
Mailing Address - Phone:781-828-3533
Mailing Address - Fax:
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:SUITE 700 JOHN CUMING BUILDING
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-369-4499
Practice Address - Fax:866-743-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34084208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty