| Doctor Name: | DR. JUSTIN RYAN BROOKS |
| NPI Number: | 1104168590 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., PH.D. |
| License Number: | 0101256800 |
| Business Practice Address: | 11500 Lipscomb Way White Marsh, MD - 21162 |
| Business Phone Number: | 7575811363 |
| Business Fax Number: | |
| Mailing Address: | 11500 Lipscomb Way, WHITE MARSH |
| State: | MD |
| Postal Code: | 21162 |
| Phone Number: | 7575811363 |
| Fax Number: | |
| NPI Enumeration Date: | 03/23/2013 |
| NPI Last Update Date: | 06/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101256800 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |