Provider Demographics
NPI:1962793604
Name:CARTER-BROOKS, CHARELLE MONIQUE (MD)
Entity type:Individual
Prefix:
First Name:CHARELLE
Middle Name:MONIQUE
Last Name:CARTER-BROOKS
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 1:106 BIDDLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3495
Mailing Address - Country:US
Mailing Address - Phone:518-429-5225
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW STE 6A-42
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD454759207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD454759OtherPA LICENSE