Provider Demographics
NPI:1801801253
Name:BROOKER, REGINALD CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:CHRISTOPHER
Last Name:BROOKER
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-763-2320
Practice Address - Fax:843-763-4198
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22878207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20081903OtherSELECT HEALTH
17550559373OtherNPPES - GROUP NPI #
1801801253OtherNPPES - INDIVIDUAL NPI #
20-8933998OtherIRS - GROUP TAX ID #
SC228783Medicaid
SC8945OtherMEDICARE GROUP PTAN #
6182010001Medicare NSC
SCAA14868945Medicare PIN
SC8945OtherMEDICARE GROUP PTAN #