Provider Demographics
NPI:1174560122
Name:BROOKS, JOHN CARTER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARTER
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:SUITE A 107
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-441-3305
Mailing Address - Fax:412-441-3324
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:SUITE A 107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-441-3305
Practice Address - Fax:412-441-3324
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050105L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA674792H97Medicare ID - Type Unspecified