Provider Demographics
NPI:1407340888
Name:BROOKS, BLAKE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:ELIZABETH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BLAKE
Other - Middle Name:ELIZABETH
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2405
Mailing Address - Country:US
Mailing Address - Phone:203-856-8644
Mailing Address - Fax:
Practice Address - Street 1:1305 POST RD STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-259-7709
Practice Address - Fax:203-255-3585
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79510207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology