Provider Demographics
NPI:1053378604
Name:BROOKS, CHARLES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
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 1:102 HANDLEY PARK CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1768
Mailing Address - Country:US
Mailing Address - Phone:919-734-3344
Mailing Address - Fax:919-735-3025
Practice Address - Street 1:102 HANDLEY PARK COURT
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-734-3344
Practice Address - Fax:919-735-3025
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28622207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8918571Medicaid
NCC87288Medicare UPIN
NC205039Medicare ID - Type UnspecifiedPHYSICIAN