Provider Demographics
NPI:1972530673
Name:BROOKS, BRYAN M (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 COX RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6753
Mailing Address - Country:US
Mailing Address - Phone:804-270-0330
Mailing Address - Fax:804-270-1003
Practice Address - Street 1:4600 COX RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6753
Practice Address - Country:US
Practice Address - Phone:804-270-0330
Practice Address - Fax:804-270-1003
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102550207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH32595Medicare UPIN