Provider Demographics
NPI:1235633538
Name:PFISTER, BROOKE (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:PFISTER
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 1:1 HARNOIS AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4395
Mailing Address - Country:US
Mailing Address - Phone:207-662-1360
Mailing Address - Fax:207-662-1361
Practice Address - Street 1:1 HARNOIS AVE STE 1A
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4395
Practice Address - Country:US
Practice Address - Phone:207-662-1360
Practice Address - Fax:207-662-1361
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75820208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics